Title

FY 2016 Proposed Rule Data Files

Type of File

Impact File and Data Files

Below are the data files and impact file for the FY 2016 Proposed Rule. The tables for the FY 2016 proposed rule are located on a separate list.

1. FY 16 NPRM Impact File: This file contains data elements by provider that were used in calculating the proposed FY 2016 rates and impacts. 
2. AOR/BOR File: This zip file contains two excel spreadsheets, one for the proposed After Outliers Removed (AOR) and one for the proposed Before Outliers Removed (BOR). There are also two files 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 2014, using the V31 Grouper).
4. FY 2016 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 2016 IPPS Proposed Rule are derived from the December 31, 2014 quarterly update of the FY 2013 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 (formerly Table 4E).
7. FY 2016 Proposed Rule Wage Index Public Use Files: Open Attached Zip file. Attached is a PDF with a description of each zip file. Main zip file contains 6 zip files:
   • FY 2016 Proposed Rule Wage Index PUFs; S3 Part II and Occ Mix Data
   • FY 2016 Proposed Rule Average Hourly Wage by Provider and CBSA Public Use File
   • FY 2016 Proposed Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
   • FY 2016 Proposed Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
   • FY 2016 Proposed Rule AHW by Provider Area Listing
   • FY 2016 Proposed Rule Puerto Rico Specific Occupational Mix Adjusted and Unadjusted AHWs by Provider PUF
8. FY 2016 IPPS Proposed Rule: Hospital Readmissions Reduction Program Supplemental Data File:  This file contains the proposed FY 2016 proxy payment adjustment factors under the Hospital Readmissions Reduction Program and the number of cases and excess readmissions ratios for the five conditions (heart failure, pneumonia and acute myocardial infarction, chronic obstructive pulmonary disease and total hip/total knee arthroplasty) used to calculate the proposed proxy payment adjustment factors. In addition, it contains information on the number of cases for each of the applicable conditions excluded in the calculation of the readmission payment adjustment factors, and it contains DRG relative weight information to estimate the proposed proxy payment adjustment factors.
9. FY 2016 IPPS Proposed Rule: Medicare DSH Supplemental Data File: This file contains the proposed FY 2016 Factor 3 and data used to calculate Factor 3 to implement Section 3133 of the ACA, Improvements to Medicare DSH Payments. In addition, the file contains the data used for Medicare DSH estimates to support of the calculation of Factor 1. Lastly, the file contains a list of hospitals that have undergone a merger so that the data of the merging hospitals has been combined to calculate the Factor 3 for the surviving hospital for FY 2016. The Factor 3 is the proportion of the uncompensated care amount that a DSH hospital will receive under the implementation of Section 3133 of the Affordable Care Act. For FY 2016, the Factor 3 is the hospital's Medicaid days and Medicare SSI days relative to all DSH hospitals Medicaid days and Medicare SSI days. DSH hospitals are identified as those hospitals that are projected to receive DSH for FY 2016.