FY 2018 IPPS NPRM: Implementation of Section 3133 of the Affordable Care Act- Medicare DSH- Supplemental Data	
	
Variable	Description
PROV	Medicare Provider Number or CMS Certification Number (CCN)
Medicaid Days	"Medicaid inpatient days reported on the hospital's 2012 and 2013 Medicare Hospital Cost Reports based on the December 2016 update of the Medicare Hospital Cost Report data. Medicaid days are those that are reported for the purpose of calculating the numerator of the Medicaid fraction for Medicare DSH. If a hospital filed more than one cost report beginning in FY 2012 or FY 2013, Medicaid inpatient days from all cost reports are used.  As finalized in the FY 2014 Final Rule, Medicaid days for DSH hospitals and SCHs were reported on Worksheet S-2 of the 2552-10 cost report. Medicaid days for non-DSH hospitals were reported on Worksheet S-3 of the 2552-10 cost report. As finalized in the FY 2015 IPPS Final Rule, Medicaid days for hospitals that underwent a merger are based on the Medicaid days reported for both hospitals."
Medicare SSI Days	"Medicare SSI days based on the most recently available SSI ratios. Medicare SSI days are based on the Federal fiscal year, based on the December 2016 update of the MedPAR. Medicare SSI days are equivalent to the Medicare SSI days used in the calculation of the SSI ratio for Medicare DSH. The SSI ratios can be found here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dsh.html.  As finalized in the FY 2015 IPPS Final Rule, SSI days for hospitals that underwent a merger are based on the SSI days reported for both hospitals."
Uncompensated Care Costs	"Sum of charity care costs and bad debt reported on Worksheet S-10 of a hospital's 2014 Medicare Hospital Cost Report based on the December 2016 update of the Medicare Hospital Cost Report data. 'N/A' indicates a Puerto Rico or IHS/Tribal hospital. For these hospitals, uncompensated care costs are not used in the calculation of Factor 3 for FY 2014. The Factor 3 from FY 2013 that is based on Medicaid days and Medicare SSI days is instead used in place of calculating a FY 2014 Factor 3 based on uncompensated care costs."
Proposed Factor 3	"Factor 3 , the uncompensated care payment factor representing the proportion of the uncompensated care amount that a DSH hospital will receive under Section 3133 of the Affordable Care Act.  Factor 3 is the hospital's burden of  uncompensated care relative to the uncompensated care burden of all DSH hospitals. For FY 2018, a hospital's Factor 3 is the average of three individual Factor 3s calculated based on cost reporting periods beginning in FY 2012, FY 2013, and FY 2014. The individual Factor 3s for FY 2012 and FY 2013 are based on Medicaid days and Medicare SSI days, while the Factor 3 for FY 2014 is based on hospital uncompensated care costs. For the proposed rule, the denominator used in teh calculation of Factor 3 for FY 2012, FY 2013, and FY 2014 cost reporting years are 36364459, 37141019, and $25,828,174,069 respectively. DSH hospitals are identified as those hospitals that are projected to receive DSH for FY 2018, according to the FY 2014 SSI ratio and Medicaid fraction reported in the December 2016 update of the Provider Specific File. If a hospital listed as ineligible for DSH and the uncompensated care payment receives DSH at cost report settlement for 2018, then the hospital will receive the uncompensated care payment based on the Factor 3 listed here.  For FY 2018, the proposed Factor 3 for DSH eligible hospitals is scaled so that total uncompensated care payments are consistent with the estimate published in the proposed rule."
Total Uncompensated Care Payment	"The total uncompensated care payment amount made for hospitals projected to receive DSH  for FY 2018. The uncompensated care payment will be paid on an interim per discharge basis and reconciled to the amount listed in this column at cost report settlement. ""N/A"" is listed for hospitals that are not projected to receive DSH, thus ineligible for the uncompensated care payment for FY 2018.  If a hospital listed as ineligible for DSH and the uncompensated care payment receives DSH at cost report settlement for 2018, then the hospital will receive the uncompensated care payment based on the Factor 3 listed here. "
Estimated Per Claim Amount	"Estimated per claim uncompensated care payment amount that will be paid on each claim for FY 2018. The total uncompensated care payment amount  in the FY 2018 IPPS Final Rule will be reconciled at cost report settlement with the interim estimated uncompensated care payments that are paid on a per discharge basis. Estimated per claim amount is determined by dividing the total uncompensated care payment by the average number of claims from the most recent three years of claims data (FY14-16). ""N/A"" is listed for hospitals that are not projected to receive DSH, thus ineligible for the uncompensated care payment for FY 2018."
Claims Average	The average number of claims from the most recent three years of claims data (FY14-16)
Projected to Receive DSH for FY 2017	"YES' indicates that hospital is projected to receive DSH for FY 2018, thus eligible to receive the additional payment for uncompensated care. 'NO' indicates that hospital is not projected to receive DSH for FY 2018, thus ineligible to receive the uncompensated care payment.'SCH' indicates that the hospital is a Sole Community Hospital that is both projected to be eligible for DSH (with a DPP greater than 15%) but projected to be paid under its hospital specific rate, not the Federal rate, thus projected to not be paid DSH and ineligible to receive the uncompensated care payment. However, for  hospitals identified as 'SCH', these hospitals are paid the higher of the Federal rate or hospital specific rate on an interim claim-by-claim basis and an estimated per discharge uncompensated care payment amount is listed for this calculation. The amount of the uncompensated care payment is based on their Factor 3 applied to the amount of money available. Hospitals currently listed as ineligible for DSH will receive an uncompensated care payment if they receive DSH in FY 2018, as determined at cost report settlement. If a hospital projected to not receive DSH receives DSH at cost report settlement, the hospital will receive the amount based on the application of the Factor 3 to the amount of money available. "
	
