Files for FY 2020 Proposed Rule and Correction Notice

Title
Files for FY 2020 Proposed Rule and Correction Notice
Fiscal Year
2020
Type of File
Tables and Data Files
Description
See below
  1. FY 2020 Proposed Rule Impact File : This file contains data elements by provider that were used in calculating the proposed FY 2020 rates and impacts. 
  2. AOR/BOR File : This zip file for the FY 2020 proposed rule contains one excel spreadsheet with multiple tabs: one for the After Outliers Removed (AOR) and one for the Before Outliers Removed (BOR). There are also two tabs containing the variable descriptions. The variables in these files are used in the calculations of the relative weights as well as other calculations for the inpatient PPS. All text files in the zip file are for 508 compliance.
  3. Case Mix Index File : This file contains the non-transfer adjusted case mix index (CMI) based on the MS-DRGs billed on the claim in the year the claim was incurred (that is, during FY 2018, using the V35 Grouper).
  4. FY 2020 Proposed Rule: HCRIS Data File : CMS uses hospital cost report data from the Medicare Cost Report, Hospital Form 2552-10, to calculate the Cost-to-Charge Ratios (CCRs) used in the cost based MS-DRG relative weight methodology. The database for the Medicare cost reports is the Healthcare Cost Report Information System (HCRIS). The CCRs used in the calculation of the MS‑DRG relative weights for the FY 2020 IPPS Proposed Rule are derived from the December 31, 2018 quarterly update of the FY 2017 HCRIS. (HCRIS is updated on a quarterly basis).
  5. Proposed Standardizing File : This file is used to standardize charges for the rate building process.
  6. County to CBSA Crosswalk File and Urban CBSAs and Constituent Counties for Acute Care Hospitals File : This file contains two tabs: A crosswalk of county codes to CBSAs and a list of Urban CBSAs and Constituent Counties for Acute Care Hospitals Files.
  7. FY 2020 Proposed Rule Wage Index Public Use Files (ZIP) : Open Attached Zip file. Attached is a PDF with a description of each zip file. Main zip file contains 6 zip files:
    • FY 2020 Proposed Rule Wage Index PUFs; S3 Part II and Occ Mix Data
    • FY 2020 Proposed Rule Average Hourly Wage by Provider and CBSA Public Use File
    • FY 2020 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
    • FY 2020 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
    • FY 2020 Proposed Rule AHW by Provider Area Listing
  8. FY 2020 IPPS Proposed Rule: Medicare DSH Supplemental Data File (ZIP) : This spreadsheet has 7 tabs (text files for each tab are included for Section 508 compliance):   The first tab is the File Layout for second tab of the spreadsheet. The second tab contains the proposed rule FY 2020 Factor 3 and data used to calculate Factor 3 to implement Section 3133 of the ACA, Improvements to Medicare DSH Payments. The third tab contains a list of hospitals that have undergone a merger where the data of the merging hospitals have been combined to calculate the Factor 3 for the surviving hospital for FY 2020. The fourth through sixth tabs are similar to the first three tabs, except reflect the alternative policy under consideration. The seventh tab contains the Medicare DSH estimates to support the calculation of the proposed Factor 1.
  9. Monthly Summary of Charges for Charge Inflation Factor (ZIP) : Excel spreadsheet contains two tabs. The first tab has monthly charges by provider from January 2017 through December 2017. The second tab has monthly charges by provider from January 2018 through December 2018.
  10. List of Lugar Counties (ZIP) : This table lists each Lugar county that is deemed urban under section 1886(d)(8)(B) of the Act. It also indicates which counties map to a different CBSA per our proposal of including outlying counties in the out commuting analysis.
  11. Lugar Hospitals in Counties that Qualify for an Outmigration Adjustment for FY 2020 : This table lists each Lugar hospital (deemed urban under section 1886(d)(8)(B) of the Act) that is located in a county that qualifies for an outmigration adjustment; the 3-year period for which the hospital is eligible for the outmigration adjustment; and whether or not the hospital accepted the outmigration adjustment in lieu of its urban status for each year of its 3-year eligibility. Please note that in the FY 2012 IPPS final rule, CMS finalized a policy that allows a Lugar hospital that is eligible for and accepts the outmigration adjustment to automatically waive its urban status for the 3-year period for which the outmigration adjustment is effective.
  12. FY 2021 New Technology Thresholds : Contains the proposed cost thresholds by MS-DRG for the cost criteria for new technology add-on payments for applications for FY 2021.
  13. Wage Index Disparities Alternatives Considered File : Contains the different wage index values, prior to the proposed application of a transition cap on decreases, under each of the alternatives considered for addressing wage index disparities that are discussed in I.O. of the Appendix A of the proposed rule.
  14. Impact on Resource Use, ICD-10-CM Diagnosis Codes with Proposed Severity Level Changes : Contains the data describing the impact on resource use when reported as a secondary diagnosis for all 1,492 ICD–10–CM diagnosis codes for which we are proposing a change in severity level designation.
  15. Hospital Readmissions Reduction Program Supplemental Data File: While the proposed rule discusses the supplemental data file, we have not updated the supplemental data file because the proposed readmissions payment adjustment factors are not available at this time because hospitals have not yet had the opportunity to review and correct the data before the data are made public under our policy regarding the reporting of hospital-specific data, and the information would be the same as the FY 2019 final rule supplemental data file. Therefore, we refer readers to the FY 2019 IPPS/LTCH PPS final rule supplemental file, which has the most recent finalized payment adjustment factor components and is the same data as would have been used to create the FY 2020 IPPS/LTCH PPS proposed rule supplemental data file.
  16. Table 1A-1E : This excel spreadsheet contains the proposed FY 2020 Operating and Capital National Standardized Amounts.
  17. FY 2020 Proposed Rule Tables 2, 3 and 4 (Wage Index Tables) :  Table 2- Proposed Case-Mix Index and Wage Index Table by CMS Certification Number (CCN); Table 3- Proposed Wage Index Table by CBSA; Table 4- Proposed List of Counties Eligible for the Out-Migration Adjustment under Section 1886(d)(13) of the Act (Updated Tables 2 and 3 on May 16, 2019)
  18. Table 5 : Proposed MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay
  19. Tables 6A-6K and Tables 6P.1c-6P.1e : Table 6A-New Diagnosis Codes; Table 6B-New Procedure Codes; Table 6C-Invalid Diagnosis Codes; Table 6D-Invalid Procedure Codes; Table 6E-Revised Diagnosis Code Titles; Table 6F-Revised Procedure Code Titles; Table 6G.1- Proposed Secondary Diagnosis Order Additions to the CC Exclusions List; Table 6G.2- Proposed Principal Diagnosis Order Additions to the CC Exclusions List; Table 6H.1- Proposed Secondary Diagnosis Order Deletions to the CC Exclusions List; Table 6H.2- Proposed Principal Diagnosis Order Deletions to the CC Exclusions List; Table 6I.1- Proposed Additions to the MCC List; Table 6I.2- Proposed Deletions to the MCC List; Table 6J.1- Proposed Additions to the CC List; Table 6J.2- Proposed Deletions to the CC List; Tables 6P.1a-6P.1e (ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes): See summary tab in excel spreadsheet called “CMS-1716-P TABLE 6P ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes.xlsx” for complete description of all tables.
  20. Tables 7A and 7B : Tables 7A and 7B contain the number of discharges, and selected percentile lengths of stay for both MS-DRGs, version 36 and MS-DRGs, proposed version 37
  21. Tables 8A, 8B, and 8C : Tables 8A and 8B contain the proposed FY 2020 IPPS operating and capital statewide average cost-to-charge-ratios. Table 8C contains the proposed FY 2020 LTCH statewide average cost-to-charge-ratios.
  22. Table 10: No longer a Table; see #12.
  23. Table 15: No longer included in the proposed rule. As discussed in the proposed rule. the proposed readmissions payment adjustment factors, which are typically included in Table 15 of the rules, are not available at this time because hospitals have not yet had the opportunity to review and correct the data before the data are made public under our policy regarding the reporting of hospital-specific data.
  24. Table 16 : Proposed Proxy Hospital Value-Based Purchasing (VBP) Program Adjustment Factors for FY 2020
  25. Table 18 : Proposed FY 2020 Medicare DSH Uncompensated Care Payment Factor 3

 

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