IPPS and LTCH Final Rule FY2019

On October 8, 2018, in Documents, by pam

On August 2, 2018, CMS released the Final Rule for IPPS and LTCH for FY2019. Corrections were issued September 28, 2018.

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2019. Some of these changes implement certain statutory provisions contained in the 21st Century Cures Act and the Bipartisan Budget Act of 2018, and other legislation. We also are making changes relating to Medicare graduate medical education (GME) affiliation agreements for new urban teaching hospitals. In addition, we are providing the market basket update that will apply to the rate of increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis, subject to these limits for FY 2019. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2019.

In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS exempt cancer hospitals, and LTCHs). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (now referred to as the Promoting Interoperability Programs). In addition, we are finalizing modifications to the requirements that apply to States operating Medicaid Promoting Interoperability Programs. We are updating policies for the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.   

We also are making changes relating to the required supporting documentation for an acceptable Medicare cost report submission and the supporting information for physician certification and recertification of claims.

Links:

Impact File and Supporting Data Files

  1. FY 19 Impact File (Final Rule and Correction Notice) [ZIP, 3MB] : This file contains data elements by provider that were used in calculating the FY 2019 rates and impacts for the FY 2019 final rule and correction notice.
  2. AOR/BOR File [ZIP, 1MB] : This zip file for the FY 2019 final 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 [ZIP, 186KB] 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 2017, using the V34Grouper).
  4. FY 2019 Final Rule: HCRIS Data File [ZIP, 24MB] : 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 2019 IPPS Final Rule are derived from the March 31, 2018 quarterly update of the FY 2016 HCRIS. (HCRIS is updated on a quarterly basis).
  5. Standardizing File [ZIP, 456KB] : 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 [ZIP, 230KB] : 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 2019 Wage Index Public Use Files (Final Rule and Correction Notice) [ZIP, 11MB] : The Attached zip file contains 2 zip files, one for the FY 2019 Final Rule and one for the one for the FY 2019 Correction Notice. Each zip file contains a PDF with a description of each zip file. Each zip file contains 6 zip files:
    • FY 2019 Wage Index PUFs; S3 Part II and Occ Mix Data
    • FY 2019 Average Hourly Wage by Provider and CBSA Public Use File
    • FY 2019 Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
    • FY 2019 Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
    • FY 2019 AHW by Provider Area Listing
  8. FY 2019 IPPS Final Rule: Hospital Readmissions Reduction Program Supplemental Data File [ZIP, 1MB]: This file contains the final FY 2019 readmissions payment adjustment factors under the Hospital Readmissions Reduction Program that will be applicable to discharges occurring on or after October 1, 2018. It also contains information on the number of cases for each of the applicable conditions and the base operating DRG payments used in the calculation of the readmission payment adjustment factors.
  9. FY 2019 IPPS Medicare DSH Supplemental Data File (Final Rule and Correction Notice) [ZIP, 1MB] : This spreadsheet has 6 tabs (text files for each tab are included for Section 508 compliance):
    • Tab 1: File Layout for the spreadsheet.
    • Tab 2: The correction notice FY 2019 Factor 3 and data used to calculate Factor 3 to implement Section 3133 of the ACA, Improvements to Medicare DSH Payments.
    • Tab 3: The list of hospitals used in the correction notice that have undergone a merger so that the data of the merged hospitals have been combined to calculate the surviving hospital’s Factor 3 for FY 2019.
    • Tab 4: The final rule FY 2019 Factor 3 and data used to calculate Factor 3 to implement Section 3133 of the ACA, Improvements to Medicare DSH Payments.
    • Tab 5: The list of hospitals used for the final rule that have undergone a merger so that the data of the merging hospitals have been combined to calculate the Factor 3 for the surviving hospital for FY 2019.
    • Tab 6: The data used for Medicare DSH estimates to support the calculation of the Factor 1. The Factor 3 in the second tab is the amount available for uncompensated care payments that a DSH hospital will receive under the implementation of Section 3133 of the Affordable Care Act. DSH hospitals are identified as those hospitals that are projected to receive DSH payments for FY 2019.
  10. Monthly Summary of Charges for Charge Inflation Factor [ZIP, 3MB] Excel spreadsheet contains two tabs. One has monthly charges by provider from April 2016 through March 2017. One has monthly charges by provider from April 2017 through March 2018.
  11. FY 2020 New Technology Thresholds (Final Rule and Correction Notice) [ZIP, 62KB] : Contains the final rule and correction notice cost thresholds by MS-DRG for the cost criteria for new technology add-on payments for applications for FY 2020. Applicants should use the correction notice version for their applications.
  12. The following files can be found on the MS-DRG Classifications and Software webpage:
    • Definition of Medicare Code Edits v36
    • ICD-10 MS-DRG Definitions Manual Files v36 (text version)
    • ICD-10-CM/PCS MS-DRG v36 Definitions Manual Table of Contents – Full Titles – HTML Versions
    • Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version 36, ICD-10 Software
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