======================
MU00.@BFN2699.LTNDM190
======================

TO: Shared System Coordinators, MEDICARE Coordinators

SUBJECT: Long-term Care Hospital (LTCH) Prospective Payment System (PPS)
         Pricer Release, Version 20190
(September 14, 2018)  --ACTION-- refer to Change Request (CR) 10869

This LTCH Pricer release is the production version for the October 2018
release.

It includes the following changes/additions:

 PRICER STANDARD FEDERAL RATES/FACTORS/POLICY:

  - STANDARD FEDERAL RATES (BASED ON QUALITY DATA REPORT STATUS
    FOR FY19):

    * FULL UPDATE (QUALITY INDICATOR ON PSF = 1): $41,558.68
    * REDUCED UPDATE (QUALITY INDICATOR ON PSF = 0 OR BLANK):
      $40,738.57

  - LABOR SHARE: 66.0% (0.660)

  - NONLABOR SHARE: 34.0% (0.340)

  - MS-LTC-DRG WEIGHTS/LENGTH OF STAY TABLE.

  - HIGH COST OUTLIER FIXED-LOSS AMOUNTS (NO POLICY/CALCULATION
    LOGIC CHANGES)

    * STANDARD RATE CASES: $27,121
    * SITE NEUTRAL RATE CASES: $25,743

  - SITE NEUTRAL RATE HCO BUDGET NEUTRALITY FACTOR: 0.949 (NO
    POLICY/CALCULATION LOGIC CHANGES)

  - SSO AND SITE NEUTRAL RATE PAYMENTS IPPS RATES/FACTORS:

      IPPS LABOR SHARE WAGE INDEX > 1: $3856.27
      IPPS NONLABOR SHARE WAGE INDEX > 1: $1789.81
      IPPS LABOR SHARE WAGE INDEX < /= 1:  $3500.57
      IPPS NONLABOR SHARE WAGE INDEX < /= 1:  $2145.51
      CAPITAL NATIONAL RATE: $459.41

    * REDUCTION FACTOR FOR IPPS COMPARABLE OPERATING DSH PAYMENT
      AMOUNT: 75.63% OR A FACTOR OF 0.7563. (THIS REDUCTION IS NOT
      APPLIED TO THE CAPITAL DSH PAYMENT CALCULATION.)

    * USE FY 2019 IPPS AREA WAGE INDEXES & MS-DRG WEIGHTS/LENGTH
      OF STAY

 - SPECIAL TREATMENT - PROVIDER 332006 (CALVARY HOSPITAL/FORMER
   SUBCLAUSE (II)) - PAYMENT LOGIC IN PRICER SPECIFIC TO THIS
   PROVIDER IS NO LONGER NEEDED SINCE UNDER CR 9912 (TRANSMITTAL
   179; FEBRUARY 3, 2017) CLAIMS FROM SUCH LTCH WITH A DISCHARGE
   DATE ON OR AFTER JANUARY 1, 2017 SHALL NO LONGER PROCESS
   THROUGH THE LTCH PRICER.


- LTDRV190    ** Replaces LTDRV183 **

    - CALL to LTCAL190 module


- LTWIX190    ** Replaces LTWIX182 **

    - FY 2019 CBSA Wage Index rates


- IPWIX190    ** Replaces IPWIX182 **

    - FY 2019 CBSA Wage Index rates


- LTDRG190    ** New **

    - FY 2019 LTCH DRG table


- IPDRG190    ** New **

    - FY 2019 IPPS DRG table

- LTCAL190 (new)

   - No logic changes



**********************

A partitioned data set (PDS) of the Version 20190 code
(MU00.@BFN2699.LTNDM190) is at the CMS Data Center for users
to obtain by Connect:Direct (Network DataMover).

The 70 members listed below comprise the Pricer, but only the modules
that changed or are new since the previous release are included in the
PDS.  The changed and new members should be used in conjunction with
the current production Pricer files.

      NAME
      --------
      BLEND152
      IPDRG063
      IPDRG071
      IPDRG080
      IPDRG090
      IPDRG104
      IPDRG110
      IPDRG123
      IPDRG130
      IPDRG141
      IPDRG152
      IPDRG160
      IPDRG170
      IPDRG181
      IPDRG190
      IPWIX190
      IRFBN091
      IRFBN102
      IRFBN105
      LTCAL032
      LTCAL042
      LTCAL043
      LTCAL058
      LTCAL059
      LTCAL063
      LTCAL064
      LTCAL072
      LTCAL075
      LTCAL080
      LTCAL087
      LTCAL091
      LTCAL094
      LTCAL095
      LTCAL103
      LTCAL105
      LTCAL111
      LTCAL123
      LTCAL130
      LTCAL141
      LTCAL152
      LTCAL154
      LTCAL162
      LTCAL170
      LTCAL183
      LTCAL190
      LTDRG031
      LTDRG041
      LTDRG057
      LTDRG062
      LTDRG075
      LTDRG080
      LTDRG086
      LTDRG093
      LTDRG095
      LTDRG100
      LTDRG110
      LTDRG123
      LTDRG130
      LTDRG141
      LTDRG152
      LTDRG160
      LTDRG170
      LTDRG180
      LTDRG181
      LTDRG190
      LTDRV190
      LTMSA152
      LTWIX190
      MANIFEST
      README

