MEDICARE WAGE INDEX	
OCCUPATIONAL MIX SURVEY	
 	
	
Introduction	
	
      Section 304(c) of Public Law 106-554 amended section 1886(d)(3)(E) of the Act 	
to require CMS to collect data every 3 years on the occupational mix of employees for 	
"each short-term, acute care hospital participating in the Medicare program, in order to "	
construct an occupational mix adjustment to the wage index.  The law also requires the 	
"application of the occupational mix adjustment to the wage index beginning October 1, "	
2004.	
 	
      This survey provides for the collection of occupational mix data for a 12-	
"month period, that is, * from pay periods ending between January 1, 2019 and "	
"December 31, 2019 to be applied to the FY 2022 wage index. Specifically, the "	
"surveys begin date cannot be earlier than December 17, 2018, and the surveys end"	
"date cannot end later than December 31, 2019. Complete the survey for any hospital "	
"that is subject to the inpatient prospective payment system (IPPS), or any hospital "	
that would be subject to IPPS if not granted a waiver1. [Note: Do not complete this 	
survey if you are a no/low Medicare utilization provider. Check with your Medicare	
Administrative Contractors (MAC) to confirm your status.] It is important for 	
hospitals to ensure that the data reported on the survey are accurate and verifiable 	
through supporting documentation.	
	
Completed occupational mix surveys must be submitted to MACs (not directly  	
"to CMS), on the Excel hospital reporting form, by July 1, 2020, via email attachment"	
or overnight delivery. CMS granted an extension for hospitals nationwide affected by	
" COVID-19 until August 3, 2020. Due to continued COVID related concerns from "	
"hospitals about meeting this deadline, CMS is further extending this deadline to"	
"September 3, 2020. Hospitals must submit their occupational mix surveys along with "	
"complete supporting documentation to their MACs by no later than September 3, 2020. "	
"Hospitals may then submit revisions to their occupational mix surveys to their MACs, if"	
"needed, by no later than September 10, 2020."	
	
The Excel version of the occupational mix survey may be obtained from MACs or 	
downloaded from CMSs website at:	
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Wage-Index-Files.html	
	
      Instructions and definitions for the data elements and the occupational categories 	
are attached.	
	
"[1]  Note: Critical Access Hospitals (CAHs) are not paid under the IPPS, therefore CAHs are not "	
"required to complete the survey.  Also, hospitals that terminated participation in the Medicare "	
"program before January 1, 2019, or terminated after January 1, 2019, but before December 2019, "	
"resulting in less than 11 months of data from CY 2019, are not required to complete the survey."	
	
"According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information "	
unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0938-	
"0907.  The time required to complete this information collection is estimated to average 480 hours per response, "	
"including the time to review instructions, search existing data resources, gather the data needed, and complete and "	
review the information collection.  If you have comments concerning the accuracy of the time estimate(s) or 	
"suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance "	
"Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.  Please do not send applications, claims, payments, "	
medical records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note	
that any correspondence not pertaining to the information collection burden approved under the associated OMB 	
"control number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns "	
"regarding where to submit your documents, please contact Tehila Lipschutz/ Noel Manlove, (410) 786-1344 / (410) "	
"786-5161, tehila.lipschutz@cms.hhs.gov / noel.manlove@cms.hhs.gov."	
	
	
Instructions and definitions for the data elements and the occupational categories.	
MEDICARE WAGE INDEX	
OCCUPATIONAL MIX SURVEY	
	
Instructions	
	
"Complete this survey for employees who are full-time and part-time, directly hired, and "	
acquired under contract.  Do not include employees in areas excluded from IPPS via 	
"Worksheet S-3, Part II, Lines 9 and 10, such as skilled-nursing facilities, psychiatric, or "	
rehabilitation units or facilities.  This exclusion applies to directly-hired and contract 	
employees who provide either direct or indirect patient care services in IPPS excluded 	
"areas. Also, do not include employees or contract labor whose services are excluded "	
"from the IPPS, such as physician Part B, and interns and residents. Include employees "	
who are allocated from the home office or related organizations to IPPS reimbursable 	
cost centers and outpatient departments of the hospital that are included in the wage 	
"index (e.g., outpatient clinic, emergency room)."	
	
"Employees in the home office, related organizations, or general services costs centers "	
"(Worksheet S-3, Part II, Lines 8, 14.01, 14.02 and Lines 26 through 43) typically provide  "	
"services throughout the hospital, including the IPPS-excluded areas (Lines 9 and 10). In "	
"completing the survey, a hospital should apply the same methodology it uses for "	
"allocating home office and related organization costs on Worksheet S-3, Part II, and "	
exclude from the survey such costs associated with excluded areas. If home office or	
" related organization personnel provide only administrative services, report their wages "	
and hours in the All Other Occupations category. To the extent that there are home	
" office or related organization personnel that are engaged in nursing activities, they must "	
be reported in the appropriate nursing subcategory.	
	
"Additionally, hospitals should apply the methodology that is used in the wage index "	
calculation for allocating general service salaries and hours to excluded areas.  (See Step 	
"4 of the wage index calculation in 76 FR 51592, August 18, 2011, or in the Wage Index "	
Calculator at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-	
Payment/AcuteInpatientPPS/Wage-Index-Files-Items/FY-2019-Wage-Index-Home-	
"Page.html.) Note that, although wage-related costs are included in the general service "	
"allocation methodology for Worksheet S-3, wage-related costs should be excluded from "	
the general service allocation methodology for the occupational mix survey because the 	
occupational mix survey excludes wage-related costs.	
	
Nursing personnel working in the following cost centers as used for Medicare cost 	
reporting purposes must be included in the appropriate nursing subcategory. These cost 	
centers reflect where the majority of nursing employees are assigned in hospitals and are 	
selected to ensure consistent reporting among hospitals. The wages and hours for nursing 	
personnel working in other areas of the hospital that are reimbursable under the IPPS or 	
"OPPS, or nurses who are performing solely administrative functions, would be included "	
in the All Other Occupations category.	
	
COST CENTER DESCRIPTIONS	Lines for 2552-10
Nursing Administration 	13
Adults and Pediatrics (General Routine Care)	30
Intensive Care Unit	31
Coronary Care Unit	32
Burn Intensive Care Unit	33
Surgical Intensive Care Unit	34
Other Special Care (specify)	35
Nursery	43
Operating Room	50
Recovery Room	51
Labor Room and Delivery Room	52
Electrocardiology	69
Renal Dialysis 	74
Ambulatory Surgical Center (Non-Distinct Part)	75
Other Ancillary	76
Clinics	90
Emergency	91
Observation Beds	92
Note: Subscripted cost centers that would normally fall into one of 	
these cost centers should be included on the survey.	
	
	
Definitions	
	
Paid Salaries and Paid Hours:	
	
Paid Salaries  Include the total of paid wages and salaries for the specified 	
"category of hospital employees including overtime, vacation, holiday, sick, lunch, "	
"and other paid-time-off, severance, and bonuses.  Do not include fringe benefits "	
"or wage-related costs as defined in Provider Reimbursement Manual, Part II, "	
Section 4005.2.	
	
Paid Hours  Include the total paid hours for the specified category of hospital 	
"employees.  Paid hours include regular hours, overtime hours, paid holiday, "	
"vacation, sick, and other paid-time-off hours, and hours associated with severance "	
pay.  Do not include non-paid lunch periods and on-call hours in the total paid 	
hours.  (Note: On-call hours for the occupational mix survey must be treated the 	
same as on-call hours for Worksheet S-3 wage data; see Provider Reimbursement 	
"Manual, Part II, 4005.2, column 5 instructions).  Overtime hours must be "	
calculated as one hour when an employee is paid time and a half.  No hours are 	
required for bonus pay.  The hours reported for salaried employees who are paid a 	
fixed rate must be recorded based on 40 hours per week or the number of hours in 	
the hospitals standard workweek.  	
	
Occupational Categories:	
	
[The occupational categories and definitions included in this survey derive directly from the U. S. 	
"Bureau of Labor Statistics (BLS), 2017 Occupational Employment Statistics survey at"	
http://www.bls.gov/oes/current/oes_stru.htm. The numbers in parentheses are the BLS standard 	
"occupational categories (SOCs). As with the BLS survey, workers should be classified in the "	
"occupation that requires their highest level of skill. If there is no measurable difference in skills, "	
workers are to be included in the occupation in which they spend the most time.]	
	
"Registered Nurses (RNs, SOC 29-1141) - Assess patient health problems and "	
"needs, develop and implement nursing care plans, and maintain medical records.  "	
"Administer nursing care to ill, injured, convalescent, or disabled patients.  May "	
advise patients on health maintenance and disease prevention or provide case 	
management.  Licensing or registration required.  RNs who have specialized 	
"formal, post-basic education and who function in highly autonomous and "	
"specialized roles, may be assigned a variety of roles such as staff nurse, advanced "	
"practice nurse, case manager, nursing educator, infection control nurse, "	
"performance improvement nurse, and community health nurse.   "	
We note that the 2017 BLS definition for Registered Nurses includes clinical 	
"nurse specialists. However, advanced practice nurses (APNs) (that is, nurse"	
"practitioners, clinical nurse specialists, certified nurse midwives, and certified "	
registered nurse anesthetists) are usually paid by Medicare under a Part B fee 	
schedule and are not included in the IPPS. APNs must be excluded from the survey if they are	
"excluded from Worksheet S-3, Part II, but should be included on the survey if "	
they are included in one of the cost centers for the survey and are included on 	
"Worksheet S-3, Part II."	
	
"Licensed Practical and Licensed Vocational Nurses (LPNs, SOC 29-2061) "	
"and Surgical Technologists** (SOC 29-2055)  LPNs: Care for ill, injured, or"	
"convalescing patients or persons with disabilities in hospitals, nursing homes, "	
"clinics, private homes, group homes, and similar institutions. May work under "	
the supervision of a registered nurse. Licensing required. Surgical 	
"Technologists: Assist in operations, under the supervision of surgeons, "	
"registered nurses, or other surgical personnel. May help set up operating room, "	
"prepare and transport patients for surgery, adjust lights and equipment, pass "	
"retractors, cut sutures, and help count sponges, needles, supplies, and "	
instruments.	
	
Nursing Assistants (SOC 31-1014) and Orderlies** (31-1015) - Nursing 	
Assistants: Provide basic patient care under direction of nursing staff. Perform	
"duties such as feed, bathe, dress, groom, or move patients, or change linens. May "	
"transfer or transport patients. Includes nursing care attendants, nursing aides, and "	
nursing attendants. Orderlies**: Transport patients to areas such as operating 	
"rooms or x-ray rooms using wheelchairs, stretchers, or moveable beds. May "	
"maintain stocks of supplies, or clean and transport equipment."	
	
Medical Assistants** (SOC 31-9092) - Performs administrative and certain 	
clinical duties under the direction of physician.  Administrative duties may 	
"include scheduling appointments, maintaining medical records, billing, and "	
coding information for insurance purposes.  Clinical duties may include taking 	
"and recording vital signs and medical histories, preparing patients for "	
"examination, drawing blood, and administering medications as directed by "	
physician.  Exclude Physician Assistants (29-1071).	
Include only those employees who perform administrative and certain clinical 	
functions under the direction of a physician in the IPPS cost centers and 	
outpatient areas of the hospital that are listed above. Do not include 	
"phlebotomists, information technology personnel, health information "	
"management personnel, medical secretaries, ward clerks, and general business "	
office personnel.	
	
	
"**Note: Medical Assistants, Orderlies, and Surgical Technologists are nursing employees for"	
"for purposes of the occupational mix survey. Whenever the terms nursing staff, nursing "	
"personnel, nursing occupations, nursing employees, or nursing categories are used "	
"with regards to the occupational mix survey, they are deemed to include medical assistants,"	
"orderlies, and surgical technologists."	
	
"Note: Only nurses, surgical technologists, nursing aides/assistants/orderlies, and medical "	
"assistants, as defined on the survey, can be included in the respective RNs, LPNs, Surgical "	
"Technologists, Aides/Assistants/Orderlies, and MAs categories. Do not include other "	
"occupations that may provide similar services as nursing personnel.  Instead, those "	
occupations (if assigned to IPPS/OPPS areas of the hospital) must be included in the All 	
"Other Occupations category.  For example, hospital-based paramedics may provide services "	
"that are similar to those provided by nursing personnel; however, on the occupational mix "	
"survey, these non-nursing occupations must be included in All Other Occupations.  This is to "	
ensure consistent reporting among hospitals.	
	
All Other Occupations  Non-nursing employees (directly hired and under 	
contract) in IPPS reimbursable cost centers and outpatient departments that are 	
"included in the wage index (e.g., outpatient clinic, emergency room) must be "	
"included in the All Other Occupations category.  In addition, this category "	
would include the wages and hours of nurses (including APNs) that function 	
"solely in administrative or leadership roles, that do not directly supervise staff "	
"nurses who provide patient care, and do not provide any direct patient care "	
themselves. This category must not include occupations that are excluded from 	
"the wage index (such as physician Part B services, interns, residents, and the "	
"services of APNs - nurse practitioners, clinical nurse specialists, certified nurse "	
"midwives, and certified registered nurse anesthetists  that are excluded from the "	
wage index because their services are billable under a Part B fee schedule).  	
"Also, the All Other Occupations category must not include employees in areas "	
"of the hospital that are excluded from the wage index via Worksheet S-3, Part II, "	
"Lines 9 and 10, such as skilled nursing, psychiatric, and rehabilitation units and "	
"facilities.  Therapists and therapy assistants, equipment technologists and "	
"technicians, medical and clinical laboratory staff, pharmacists and pharmacy "	
"technicians, administrators (other than nursing), computer specialists, dietary, and "	
housekeeping staff are examples of employees who should be reported in the All 	
Other Occupations category.  Also include the wages and hours of personnel 	
from the home office or related organizations if they perform solely 	
administrative functions and work in IPPS cost centers and outpatient departments 	
that are included in the wage index.	
	
"Note: Do not include salaries and hours for APNs (nurse practitioners, clinical nurse "	
"specialists, nurse midwives, or certified registered nurse anesthetists) in any of the Nursing "	
or All Other Occupations categories if their services are billable under Medicare Part B.  	
The services of these nurses are generally billable under a Part B fee schedule and excluded 	
from the wage index because they are not paid under the hospital inpatient prospective 	
payment system (IPPS).  	
	
	
	
