	"Instructions for Pension Prefunding Worksheet
(Determination of a Pension Prefunding Balance and Installment is Optional)"
	"This worksheet was developed as a tool to assist providers and Medicare contractors in developing the pension costs to be reported for wage index purposes per the policy adopted in the FY 2012 IPPS final rule (CMS-1518-F; 76 FR 51586 - 51590, August 18, 2011).  

Note: Only defined benefit pension plans which meet the applicable requirements for a qualified pension plan under Section 401(a) of the Internal Revenue Code are subject to the policy adopted in the FY 2012 IPPS final rule 

The use of this worksheet is not required.
"
	
Line	
	STEP 1
1	"2013 is the Wage Index FY when the prefunding balance and prefunding installment were first effective.  If a Pension Prefunding Worksheet was prepared for FY 2013, 2014, 2015, 2016, 2017 or FY 2018, providers should not complete a new Pension Prefunding Worksheet for FY 2019 unless they are revising the prior Pension Prefunding Worksheet along with supporting documentation.  Instead, enter the amount computed on Line 8 of the FY 2013, 2014, 2015,  2016, 2017 or FY 2018 Pension Prefunding Worksheet onto Line 17 of the FY 2019 Wage Index Pension Cost Worksheet. If the provider did not fill out a Pension Prefunding Worksheet for FY 2013, 2014, 2015, 2016, 2017, or 2018 continue with the instructions in the row below."
2	Enter the provider's cost reporting period to be used for the FY 2013 Wage Index.  This cost period must commence in the Medicare FY commencing 10/1/2008 and ending 9/30/2009 (four years prior to the Wage Index year shown in Line 1). 
3	Enter the day prior to the provider cost reporting period shown on Line 2.  This is the end of the lookback period.
4	Enter the first day of the provider's first cost reporting period which commences on or after 10/1/2002.  This is the earliest possible date in the lookback period.
	STEP 2 
5	"Column A: Begin by entering the cost reporting period ending on the date shown on Line 3, and work backward to  the cost reporting period commencing on the date shown on Line 4.  "
	Column B: The contribution data must include only payments made during each cost reporting period on a cash basis.  Note that the contributions reflected in this table may not agree with the contributions recognized as funding for purposes of determining the reportable cost for those prior periods because the rules previously in effect allowed contributions to be reported on an accrual basis.  A providers share of the total contributions made under a pension plan that covers multiple providers or employers shall be determined on a basis consistent with the methodology used to determine the wage index pension costs for the cost reporting periods included in the prefunding balance. 
	"Column C: The pension costs reported should be the amounts actually reflected in the wage index, after adjustments if any. For a cost reporting period that was not used for wage index reporting because there were multiple cost reporting periods commencing during the applicable Medicare FY, enter ""0"" as the cost reported for that period."
	"Column D: enter an ""X""  any cost reporting period to be excluded from the lookback period.  If documentation does not exist to substantiate the data for any period, you must exclude that period and all prior periods.  The provider may also elect to exclude any cost reporting period for which data is available, provided all previous cost reporting periods are also excluded.  Periods prior to  a period which is excluded must also be excluded in order to satisfy the requirement that the lookback period reflect consecutive periods. "
6	Total Column B (Contributions) and Column C (Wage Index Pension Costs) for each period listed in Line 5 which is not excluded.  
7	"The prefunding balance is equal to Line 6 Column B minus Line 6 Column C, but not less than ""0""."
8	"The annual prefunding installment is the prefunding balance from Line 7 divided by 10.  This amount should be entered on Line 17 of the Wage Index Pension Cost Worksheet used to determine the pension cost for the FY 2013- FY 2022 Wage Index. NOTE: No matter which Fiscal Year a provider first filled out the prefunding worksheet, it can only claim one tenth of the prefunding balance each year until Fiscal Year 2022. After Fiscal Year 2022, CMS will no longer recognize any prefunding balance (for any provider) per the policy finalized in the FY 2012 IPPS final rule."
	
	
	
	
	
	
	
	
	
	
	
	
