FY 2020 IPPS Final Rule Correction Notice: Implementation of Section 3133 of the Affordable Care Act- Medicare DSH- Supplemental Data	
	
Variable	Description
Medicare CCN	CMS Certification Number (CCN)
Projected to Receive DSH in FY 2020	"YES' indicates that hospital is projected to receive DSH for FY 2020, thus eligible to receive uncompensated care payment.  'NO' indicates that hospital is not projected to receive DSH for FY 2020, thus ineligible to receive the uncompensated care payment. SCH indicates that the hospital is a Sole Community Hospital that is projected to be paid under its hospital specific rate, not the Federal rate, thus projected to not be paid DSH and ineligible to receive the uncompensated care payment. However, for  hospitals identified as 'SCH', these hospitals are paid the higher of the Federal rate or hospital specific rate on an interim claim-by-claim basis and an estimated per discharge uncompensated care payment amount is listed for this calculation.  'N/A' indicates a hospital with 'YES' for 'New Hospital' column.

DSH hospitals are projected to receive DSH for FY 2020, based on the recently released FY 2017 SSI ratios and the Medicaid ratios from the March 2019 update of the Provider Specific File. For hospitals that are currently projected ineligible, will receive an uncompensated care payment, if determined DSH eligible at cost report settlement."
IHS or PR	"YES indicates that the hospital is either part of the Indian Health Service (IHS) or is located in Puerto Rico (PR). For these hospitals, Worksheet S-10 data are not used in the calculation of Factor 3, and instead Factor 3 is calculated using Medicaid days from FY 2013 and Medicare SSI days from FY 2017."
Rural Community Hospital Demonstration	"YES indicates that the hospitals is participating in the Rural Commnuity Hosptial Demonstration, thus not elgible for DSH in FY 2020."
New Hospital	"YES indicates whether a hospital is defined as new for purposes of uncompensated care payment methodology for FY 2020. New hospitals do not receive interim uncompensated care payments. However, if the hospital is later determined to be eligible to receive empirically justified Medicare DSH payments based on its FY 2020 cost report, the hospital will also receive an uncompensated care payment calculated using a Factor 3, where the numerator is the uncompensated care costs reported on Worksheet S–10 of the hospital’s FY 2020 cost report, and the denominator is the sum of uncompensated care costs reported on Worksheet S–10 of all DSH eligible hospitals’ FY 2015 cost reports.  For FY 2020,  CCNs established on or after October 1, 2015 will be considered new and subject to this policy. However, Indian Health Service (IHS) hospitals or hospitals located in Puerto Rico (PR) with a CCN established on or after October 1, 2013 will be considered new and subject to this policy."
2013 Medicaid Days	"Medicaid inpatient days reported on the hospital's 2013 Medicare Hospital Cost Reports based on a June 2019 update of the Medicare Hospital Cost Report data. Medicaid days are those that are reported for the purpose of calculating the numerator of the Medicaid fraction for Medicare DSH. If a hospital filed more than one cost report beginning in FY 2013, Medicaid inpatient days from the longest cost report was used, unless that cost report spanned FY 2014. As finalized in the FY 2015 IPPS Final Rule, Medicaid days for hospitals that underwent a merger are based on the Medicaid days reported for both hospitals. Medicaid days reported in this file have been annualized based upon the length of the cost reporting year of the hospital, as finalized in the FY 2018 IPPS Final Rule. "
Length of 2013 Reporting Period	"The length of the cost reporting period of the hospital, in days, based on a June 2019 update of the Medicare Hospital Cost Report data. This value was used in annualizing Medicaid days for FY 2013."
2017 SSI Days	"Medicare SSI days for 2017 are based on the most recently available SSI ratios.  Medicare SSI days are equivalent to the Medicare SSI days used in the calculation of the SSI ratio for Medicare DSH. The SSI ratios can be found here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dsh.html.  As finalized in the FY 2015 IPPS Final Rule, SSI days for hospitals that underwent a merger are based on the SSI days reported for both hospitals. A value of 'N/A' indicates that the hospital did not report 2013 Medicaid Days so 2017 SSI Days were not used to calculate 2013 Low Income Insured Days."
2015 UCC	"Sum of charity care costs and bad debt reported on Worksheet S-10 of a hospital's FY 2015 Medicare Hospital Cost Report based on a June 2019 update of the Medicare Hospital Cost Report data. 'N/A' indicates a hospital in Puerto Rico or an IHS/Tribal hospital. For hospitals in Puerto Rico and IHS/Tribal hospitals, uncompensated care costs are not used in the calculation of Factor 3 for FY 2015. The Factor 3 from FY 2013 that is based on Medicaid days and Medicare SSI days is instead used in place of developing a Factor 3 based on uncompensated care costs for FY 2015. As finalized in the FY 2018 IPPS Final Rule, uncompensated care costs for hospitals that underwent a merger are based on the uncompensated care costs reported for both hospitals. Also as finalized in the FY 2018 IPPS Final rule, uncompensated care costs have been annualized based upon the length of the hospital's cost reporting period."
Length of 2015 Reporting Period	"The length of the cost reporting period of the hospital, in days, based on a June 2019 update of the Medicare Hospital Cost Report data. This value was used in annualizing uncompensated care costs for FY 2015."
Factor 3	"Factor 3 is the factor representing the proportion of the uncompensated care amount that a DSH hospital will receive under Section 3133 of the Affordable Care Act.  Factor 3 is the hospital's burden of  uncompensated care relative to the uncompensated care burden of all DSH hospitals. For FY 2020, the Factor 3 is based on FY 2015 hospital uncompensated care costs. However, the Factor 3 for hospitals in Puerto Rico or IHS and Tribal hospitals is based on FY 2013  Medicaid days and FY 2017 Medicare SSI days.

For this final rule,
- the Factor 3 denominator for PR and IHS/Tribal hospital is 37,484,616 days. 
- the Factor 3 denominator for the remaining DSH eligible hospitals, excluding PR and IHS/Tribal hospitals, is $29,616,638,717.43. 

After calculating the Factor 3 for DSH eligible PR and IHS/Tribal hospitals, the remaining total uncompensated care payments are calculated based on the remaining DSH eligible hospitals. The sum of the Factor 3s (total uncompensated care payments) for DSH eligible hospitals, excluding PR and IHS hospitals, is approximately 0.984971301. The total of Factor 3s across PR, IHS/Tribal hospitals, and remaining DSH eligible hospitals, is approximately 1.

If a hospital currently projected as ineligible for DSH is determined to be DSH eligible at cost report settlement, then the hospital will receive the uncompensated care payment based on the Factor 3 listed here.  "
Total Uncompensated Care Payment	"The total uncompensated care payment amount made for hospitals projected to receive DSH  for FY 2020. The uncompensated care payment will be paid on an interim per discharge basis and reconciled to the amount listed in this column at cost report settlement. 'N/A' is listed for hospitals that are not projected to receive DSH and are thus ineligible for the uncompensated care payment for FY 2020.  If a hospital listed as ineligible for DSH and the uncompensated care payment receives DSH at cost report settlement for 2020, then the hospital will receive the uncompensated care payment based on the Factor 3 listed here. "
Estimated Per Claim Amount	"Estimated per claim uncompensated care payment amount that will be paid on each claim for FY 2020. The total uncompensated care payment amount in the FY 2020 IPPS Final Rule will be reconciled at cost report settlement with the interim estimated uncompensated care payments that are paid on a per discharge basis. Estimated per claim amount is determined by dividing the total uncompensated care payment by the average number of claims from the most recent three years of claims data (FYs 2016-2018). The average number of claims can be found in the variable BILLS on the FYs 2018 and 2019 IPPS FR and CN Impact File and the FY 2020 IPPS FR Impact File. 'N/A' is listed for hospitals that are not projected to receive DSH, thus ineligible for the uncompensated care payment for FY 2020."
BILLSV33	"Total number of Medicare cases for the provider as reported on the FY 2018 IPPS FR and CN Impact File. If the hospital was the surviving hospital in a merger, this column combines the data of the surviving and acquired hospital(s) involved in the merger."
BILLSV34	"Total number of Medicare cases for the provider as reported on the FY 2019 IPPS FR and CN Impact File. If the hospital was the surviving hospital in a merger, this column combines the data of the surviving and acquired hospital(s) involved in the merger."
BILLSV35	"Total number of Medicare cases for the provider as reported on the FY 2020 IPPS FR and CN Impact File. If the hospital was the surviving hospital in a merger, this column combines the data of the surviving and acquired hospital(s) involved in the merger."
Claims Average	"The average number of claims from the most recent three years of claims data (FYs 2016-2018). The average number of claims for each year can be found in the variable BILLS on the FYs 2018 and 2019 IPPS FR and CN Impact File and the FY 2020 IPPS FR Impact File. If the hospital was the surviving hospital in a merger, this average column accounts for the data of the surviving and acquired hospital(s) involved in the merger."
