      *********************************************
      *   11/14/2014  RELEASE - V20150            *
      *            Production                     *
      *********************************************
NOTE TO: Shared System Coordinators, MEDICARE Coordinators

SUBJECT: Federally Qualified Health Center (FQHC) Prospective Payment
         System (PPS) GAF Table for Pricer Release, Version 20150
(January 1, 2015)  --ACTION-- Refer to CMS change request CR #8854

This release of the FQHC PPS GAF Table for Pricer is designed to be
implemented in conjunction with the exisiting version 2014.0 of the
FQHC PPS Pricer delivered on August 8, 2014 on or about January 1, 2015.

The following updates were made to the GAF table:
  - Added GAF rates effective January 1, 2015
  - Added GAF rates effective April 1, 2015
  **********************************************


A partitioned data set of the Version 20150 data
(MU00.@BF12390.FQHC.V20150.COBOL) is at the CMS Data Center for users
to obtain by Connect:Direct (Network DataMover).
The 3 members:

1  copybook   - COPYGAF

1  databook   - BASEGAF

1  text file  - copy of this V20150 Release Memorandum
              - MEMO


If you have any questions concerning this release or any other FQHC
Pricer-related issues, please call Tracey Mackey - (410) 786-5736.





                              Tamara Howard
                              Computer Specialist/Systems Analyst
                              Division of Data Systems
                              CMS/CMM/PBG/DDS



FQHC Pricer Release V20150 Notes:    Page 1 of 2

Below are brief descriptions of the FQHC Pricer modules in
Version 20150 of the system plus a copy of the Linkage Section and
the CALL statement needed to access the module.

BASEGAF  - human-readable data from which the COPYGAF copybook is built

COPYGAF  - copybook of GAF rates by carrier-locality for FQHCCAL

MEMO     - copy of this memorandum




This is the LINKAGE SECTION defined in FQHCCAL.


       LINKAGE SECTION.

      ***************************************************************
      ***************************************************************
      ***                                                         ***
      **         LINKAGE SECTION INPUT AND OUTPUT RECORDS          **
      ***                                                         ***
      ***************************************************************
      ***************************************************************
      *                                                             *
      *   1) INPUT RECORD FROM CONTRACTOR                           *
      *   2) OUTPUT RECORD TO CONTRACTOR                            *
      *                                                             *
      ***************************************************************


      ***************************************************************
      *  INPUT RECORD FROM THE CONTRACTOR                           *
      *-------------------------------------------------------------*
      * BELOW ARE THE VARIABLES THAT WILL BE PASSED TO PRICER FROM  *
      * THE CONTRACTOR (INCLUDES ITEMS FROM THE CLAIM AND IOCE;     *
      * CLAIM LEVEL AND LINE LEVEL VARIABLES)                       *
      ***************************************************************
       01  INPUT-RECORD.
           05  I-CLAIM-LEVEL-INPUT.
               10  I-PROVIDER-NUMBER          PIC X(06).
               10  I-CARRIER-LOCALITY.
                   15  I-CARRIER              PIC X(05).
                   15  I-LOCALITY             PIC X(02).
               10  I-MA-PLAN-AMT              PIC 9(09)V99.
               10  I-SRVC-FROM-DATE           PIC 9(08).
               10  I-SRVC-THRU-DATE           PIC 9(08).
               10  I-SRVC-LINE-CNT            PIC 9(03).
           05  I-SERVICE-LINE OCCURS 450 TIMES
                     DEPENDING ON I-SRVC-LINE-CNT.
               10  I-LINE-LEVEL-INPUT.
                   15  I-HCPCS                PIC X(05).
                   15  I-MODIFIERS.
                       20  I-MODIFIER-1       PIC X(02).
                       20  I-MODIFIER-2       PIC X(02).
                       20  I-MODIFIER-3       PIC X(02).
                       20  I-MODIFIER-4       PIC X(02).
                       20  I-MODIFIER-5       PIC X(02).
                   15  I-LINE-SRVC-DATE       PIC 9(08).
                   15  I-REVENUE-CODE         PIC X(04).
                   15  I-TOT-UNITS            PIC 9(09).
                   15  I-COV-UNITS            PIC 9(09).
                   15  I-COV-CHARGES          PIC 9(09)V99.
               10  I-IOCE-LINE-FLAGS.
                   15  I-SRVC-IND             PIC X(02).
                   15  I-PYMT-IND             PIC X(02).
                   15  I-DISCOUNT-FACT        PIC 9(01).
                   15  I-LITEM-DENY-REJ-FLAG  PIC X(01).
                   15  I-PKG-FLAG             PIC X(01).
                   15  I-PYMT-ADJ-FLAG        PIC X(02).
                   15  I-PYMT-METHOD-FLAG     PIC X(01).
                   15  I-LITEM-ACT-FLAG       PIC X(01).
                   15  I-COMP-ADJ-FLAG        PIC X(02).



      ***************************************************************
      *  OUTPUT RECORD TO THE CONTRACTOR                            *
      *-------------------------------------------------------------*
      *   BELOW ARE THE VARIABLES THAT WILL BE PASSED BACK TO THE   *
      *   CONTRACTOR ASSOCIATED WITH THE BILL BEING PROCESSED       *
      ***************************************************************
       01  OUTPUT-RECORD.
           05  O-CLAIM-LEVEL-OUTPUT.
               10  O-CALC-VERS                PIC X(07).
               10  O-TOT-CLM-PYMT             PIC 9(09)V99.
               10  O-TOT-CLM-COIN             PIC 9(09)V99.
               10  O-GEO-ADJ-FACT             PIC 9(01)V9(04).
               10  O-CLM-RETURN-CODE          PIC 9(02).
           05  O-LINE-LEVEL-OUTPUT OCCURS 450 TIMES
                   DEPENDING ON I-SRVC-LINE-CNT.
               10  O-LITEM-PYMT               PIC 9(09)V99.
               10  O-LITEM-ADD-ON-PYMT        PIC 9(09)V99.
               10  O-LITEM-COIN               PIC 9(09)V99.
               10  O-LITEM-RETURN-CODE        PIC 9(02).



   ***************************************************************
   *    PROCESSING:                                              *
   *        Below is the CALL STATEMENT and variables listed     *
   *             required by the FQHCCAL module.                 *
   ***************************************************************

       PROCEDURE DIVISION  USING INPUT-RECORD
                                 OUTPUT-RECORD.


