FY 2019 IPPS Notice of Proposed Rulemaking: Implementation of Section 3133 of the Affordable Care Act- Medicare DSH- Supplemental Data	
	
Variable	Description
Medicare CCN	Medicare Provider Number or CMS Certification Number (CCN)
Projected to Receive DSH in FY 2019	"YES indicates that hospital is projected to receive DSH for FY 2019, thus eligible to receive the additional payment for uncompensated care. NO indicates that hospital is not projected to receive DSH for FY 2019, 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 2019, 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. "
"IHS,PR, or AIRP"	"Value of 1 indicates that the hospitals is either part of the Indian Health Service (IHS) and Tribal hospitals; located in Puerto Rico (PR); or an all-inclusive rate provider (AIRP). For these hospitals, uncompensated care costs are not used in the calculation of Factor 3 for FYs 2014 and 2015. The Factor 3 from FY 2013 that is based on Medicaid days and Medicare SSI days is instead used in place of developing a Factor 3 based on uncompensated care costs for FYs 2014 and 2015. "
New Hospital	"Indicates whether a hospital is new. New hospitals do not receive either interim empirically justified Medicare DSH payments or interim uncompensated care payments. However, if the hospital is later determined to be eligible to receive empirically justified Medicare DSH payments based on its FY 2019 cost report, the hospital will also receive an uncompensated care payment calculated using a Factor 3, where the numerator is the uncompensated care costs reported on Worksheet S10 of the hospitals FY 2019 cost report, and the denominator is the sum of uncompensated care costs reported on Worksheet S10 of all DSH eligible hospitals FY 2015 cost reports.  For FY 2019, any hospitals with a CCN established on or after October 1, 2015 will be considered new and subject to this policy. "
2013 Medicaid Days	"Medicaid inpatient days reported on the hospital's 2013 Medicare Hospital Cost Reports based on a February 2018 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 2013, Medicaid inpatient days from the longest cost report was used, unless that cost report spanned FY 2014. 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. Medicaid days reported in this file have been annualized based upon the length of the cost reporting year of the hospital, as finalized in the FY 2018 IPPS Final Rule. A value of ""N/A"" indicates that the hospital was not in existance in FY 2013 and thus will not have a Factor 3 for this year."
Length of 2013 Reporting Period	"The length of the cost reporting period of the hospital, in days, based on a February 2018 update of the Medicare Hospital Cost Report data. This value was used in annualizing Medicaid days for FY 2013."
2016 SSI Days	"Medicare SSI days for 2016 based on the most recently available SSI ratios. Medicare SSI days are based on the Federal fiscal year, based on the December 2017 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. A value of ""N/A"" indicates that the hospital did not report 2013 Medicaid Days so 2016 SSI Days were not used to calculate 2013 Low Income Insured Days."
2014 UCC	"Sum of charity care costs and bad debt reported on Worksheet S-10 of a hospital's FY 2014 Medicare Hospital Cost Report based on a February 2018 update of the Medicare Hospital Cost Report data. 'N/A' indicates a SCH or a hospital in Puerto Rico, an All Inclusive Rate Provider, or an IHS/Tribal hospital. For hospitals in Puerto Rico, All Inclusive Rate Providers, and IHS/Tribal hospitals, uncompensated care costs are not used in the calculation of Factor 3 for FYs 2014 and 2015. The Factor 3 from FY 2013 that is based on Medicaid days and Medicare SSI days is instead used in place of developing a Factor 3 based on uncompensated care costs for FYs 2014 and 2015. As finalized in the FY 2018 IPPS Final Rule, uncompensated care costs for hospitals that underwent a merger are based on the uncompensated care costs reported for both hospitals. Also as finalized in the FY 2018 IPPS Final rule, uncompensated care costs have been annualized based upon the length of the hospital's cost reporting period."
Length of 2014 Reporting Period	"The length of the cost reporting period of the hospital, in days, based on a February 2018 update of the Medicare Hospital Cost Report data. This value was used in annualizing uncompensated care costs for FY 2014."
2015 UCC	"Sum of charity care costs and bad debt reported on Worksheet S-10 of a hospital's FY 2015 Medicare Hospital Cost Report based on a February 2018 update of the Medicare Hospital Cost Report data. 'N/A' indicates a SCH or a hospital in Puerto Rico, an All Inclusive Rate Provider, or an IHS/Tribal hospital. For hospitals in Puerto Rico, All Inclusive Rate Providers, and IHS/Tribal hospitals, uncompensated care costs are not used in the calculation of Factor 3 for FYs 2014 and 2015. The Factor 3 from FY 2013 that is based on Medicaid days and Medicare SSI days is instead used in place of developing a Factor 3 based on uncompensated care costs for FYs 2015 and 2015. As finalized in the FY 2018 IPPS Final Rule, uncompensated care costs for hospitals that underwent a merger are based on the uncompensated care costs reported for both hospitals. Also as finalized in the FY 2018 IPPS Final rule, uncompensated care costs have been annualized based upon the length of the hospital's cost reporting period."
Length of 2015 Reporting Period	"The length of the cost reporting period of the hospital, in days, based on a February 2018 update of the Medicare Hospital Cost Report data. This value was used in annualizing uncompensated care costs for FY 2015."
Cost Reporting Years	"Number of cost reporting periods with data.  For FY 2019, the sum of the individual Factor 3 values calculated for FY
2013, FY 2014, and FY 2015 are divided by the number of cost reporting periods with data to compute an average Factor 3. "
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 2019, a hospital's Factor 3 is the average of three individual Factor 3s calculated based on cost reporting periods beginning in FY 2013, FY 2014, and FY 2015. The individual Factor 3 for FY 2013 is based on Medicaid days and Medicare SSI days, while the Factor 3 for FY 2014 and FY 2015 is based on hospital uncompensated care costs. For the proposed rule, the denominator used in the calculation of Factor 3 for FY 2013, FY 2014, and FY 2015 cost reporting years are 37,547,043; $33,481,102,564; and $32,451,322,693 respectively. We note that we have applied a scaling factor of 0.9723645631 to ensure that total uncompensated care costs match the FY 2019 amount of $8,250,415,972.16.  DSH hospitals are identified as those hospitals that are projected to receive DSH for FY 2019, according to the SSI ratio and Medicaid fraction reported in the December 2017 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 2019, then the hospital will receive the uncompensated care payment based on the Factor 3 listed here.  For FY 2019, the proposed Factor 3 for DSH eligible hospitals is scaled so that total uncompensated care payments are consistent with the estimate published in the final rule."
Total Uncompensated Care Payment	"The total uncompensated care payment amount made for hospitals projected to receive DSH  for FY 2019. 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 and are thus ineligible for the uncompensated care payment for FY 2019.  If a hospital listed as ineligible for DSH and the uncompensated care payment receives DSH at cost report settlement for 2019, 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 2019. The total uncompensated care payment amount in the FY 2019 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 (FY15-17). The average number of claims can be found in the variable BILLS on the FYs 2017 and 2018 IPPS FR and CN Impact Table and the FY 2019 IPPS Proposed Rule Impact Table. ""N/A"" is listed for hospitals that are not projected to receive DSH, thus ineligible for the uncompensated care payment for FY 2019."
Claims Average	The average number of claims from the most recent three years of claims data (FYs 15-17). The average number of claims for each year can be found in the variable BILLS on the FYs 2017 and 2018 IPPS FR and CN Impact Table and the FY 2019 IPPS Proposed Rule Impact Table.
