  F Y   2 0 1 4   I P P S   P r o p o s e d   R u l e   :   S u p p l e m e n t a l   I n f o r m a t i o n   o n   t h e   P r o p o s e d   M e d i c a r e   D S H   E s t i m a t e s   a n d     P r o p o s e d   F a c t o r   1   i n   S u p p o r t   o f   I m p l e m e n t a t i o n   o f   S e c t i o n   3 1 3 3   o f   t h e   A f f o r d a b l e   C a r e   A c t   	 	 	 	 	 	 
 
 A s   c a l c u l a t e d   b y   t h e   C M S   O f f i c e   o f   t h e   A c t u a r y 	 	 	 	 	 	 
 
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 
 2 0 0 9     M e d i c a r e   D S H   P a y m e n t s   a s   r e p o r t e d   o n   D e c e m b e r   2 0 1 2   U p d a t e   o f   t h e   M e d i c a r e   H o s p i t a l   C o s t   R e p o r t   ( i n   m i l l i o n s ) 	 	 	 	 	 	 
 
 " $ 1 0 , 1 1 9 " 	 	 	 	 	 	 
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 	 	 	 	 	 	 
 
 " A m o u n t   i n c l u d e s   M e d i c a r e   D S H   p a y m e n t s   f o r   M a r y l a n d   h o s p i t a l s ,   S o l e   C o m m u n i t y   H o s p i t a l s   a n d     h o s p i t a l s   i n   t h e   R u r a l   C o m m u n i t y   H o s p i t a l   D e m o n s t r a t i o n " 	 	 	 	 	 	 
 
 	 	 	 	 	 	 
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 I n c r e a s e s   f r o m   2 0 0 9 	 	 	 	 	 	 
 
 	 	 	 	 	 	 
 
 F Y 	 U p d a t e 	 D i s c h a r g e 	 C a s e   m i x 	 O t h e r 	 T o t a l 	 M e d i c a r e   D S H   ( i n   m i l l i o n s ) 
 
 2 0 1 0 	 1 . 0 1 8 5 	 1 . 0 0 0 7 	 1 . 0 0 6 	 1 . 0 0 8 5 0 	 1 . 0 3 4 0 4 4 	 " $ 1 0 , 4 6 3 " 
 
 2 0 1 1 	 0 . 9 9 4 5 	 1 . 0 0 8 8 	 1 . 0 0 0 	 1 . 0 6 1 6 0 	 1 . 0 6 5 0 5 2 	 " $ 1 1 , 1 4 4 " 
 
 2 0 1 2 	 0 . 9 9 9 0 	 0 . 9 8 9 2 	 1 . 0 0 7 	 1 . 0 4 5 0 0 	 1 . 0 3 9 9 0 9 	 " $ 1 1 , 5 8 9 " 
 
 2 0 1 3 	 1 . 0 2 8 0 	 1 . 0 0 0 4 	 1 . 0 0 5 	 0 . 9 9 3 5 0 	 1 . 0 2 6 8 3 5 	 " $ 1 1 , 9 0 0 " 
 
 2 0 1 4 	 0 . 9 9 6 0 	 1 . 0 3 0 5 	 1 . 0 0 5 	 1 . 0 0 5 1 5 	 1 . 0 3 6 8 2 2 	 " $ 1 2 , 3 3 8 " 
 
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 
 " " " D i s c h a r g e " "   c o l u m n   r e f l e c t s   a s s u m p t i o n s   f o r   a l l   i n p a t i e n t   h o s p i t a l s ,   n o t   l i m i t e d   t o   I P P S   h o s p i t a l s . " 	 	 	 	 	 	 
 
 " " " O t h e r " "   c o l u m n   i n c l u d e s   i m p a c t   o f   o n l y   I P P S   d i s c h a r g e s   a n d     i m p a c t   o f   D S H   p a y m e n t s   i n c r e a s i n g   o r   d e c r e a s i n g   a t   a   d i f f e r e n t   r a t e   t h a n   o t h e r   I P P S   p a y m e n t s . " 	 	 	 	 	 	 
 
 	 	 	 	 	 	 
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 " " " U p d a t e " "   c o l u m n   i s   d e t e r m i n e d   a s   f o l l o w s : " 	 	 	 	 	 	 
 
 	 	 	 	 	 	 
 
 F Y 	 M a r k e t   B a s k e t   U p d a t e 	 R e d u c t i o n s   u n d e r   A f f o r d a b l e   C a r e   A c t 	 P r o d u c t i v i t y   A d j u s t m e n t 	 D o c u m e n t a t i o n   &   C o d i n g   A d j u s t m e n t 	 T o t a l 	 
 
 2 0 1 0 	 2 . 1 	 0 . 2 5 	 	 	 1 . 8 5 	 
 
 2 0 1 1 	 2 . 6 	 0 . 2 5 	 	 - 2 . 9 	 - 0 . 5 5 	 
 
 2 0 1 2 	 3 . 0 	 0 . 1 	 1 . 0 	 - 2 . 0 	 - 0 . 1 	 
 
 2 0 1 3 	 2 . 6 	 0 . 1 	 0 . 7 	 1 . 0 	 2 . 8 	 
 
 2 0 1 4 	 2 . 3 	 0 . 3 	 0 . 4 	 - 2 . 0 	 - 0 . 4 	 
 
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 
 A l l   n u m b e r s   b a s e d   o n   F Y   2 0 1 4   B u d g e t   p r o j e c t i o n s   a n d   i s   u s e d   f o r   t h e   P r e s i d e n t ' s   B u d g e t . 	 	 	 	 	 	 
 
 