==============================================================
MU00.@BFN2699.INNDM200
========================================================================

NOTE TO: Shared System Coordinators, MEDICARE Coordinators

SUBJECT: Inpatient Prospective Payment System (IPPS) Pricer System
         Release, Version 2020.0 (CMS Change Request: CR 11361)
         ---------------------------------------------------------
         Pricer Release Date:      September 19, 2019
         Pricer Effective Date:    October 1, 2019
         CR Implementation Date:   October 7, 2019

This IPPS Pricer release is the PRODUCTION version for the October
2020 release. The 20.0 IPPS Pricer release revises the latest IPPS
Pricer release which was the PRODUCTION (19.2) release for FY 2019.

It includes the following changes:

  - Revised member, "README", to describe the release.

  - Revised member, "MANIFEST", which lists members included and
    omitted from the release dataset.  CMS is only sending members
    that changed since the previous release.

  - Added new copybook, "CBSA200", which contains all wage indices by
    CBSA from FY 2005 to FY 2020. Replaces the "CBSA190" copybook.

  - Added new copybook, "DRGSX200", which contains the entirety of the
    01 level PPS-DRG-TABLE. Replaces the "DRGSX190" copybook.

  - Added new copybook, "HOUTI200", which contains all historical
    outmigration factors, sorted by FIPS county code and fiscal year,
    for use in applying the outmigration adjustment to the wage index of
    eligible providers. Replaces the "HOUTI190" copybook.

  - Added new copybook, "NTECH200", which contains the entirety of the
    01  WK-NEW-TECH-VARIABLES. This copybook updates the FY 2019
    copybook, "NTECH192", per the notes under PPCAL200.

  - Revised copybook, "PPHOLDAR", which contains the 01 level Hold-Area
    Updated with the FY20 Final Rule/Correction Notice.
      NOTE: All PPCAL*** programs which call the previous
      version of this copybook need to be recompiled.

      Inserted:
        05  H-BUDG-NUTR200               PIC 9(01)V9(06).

        05  H-UPDATE-200                 PIC 9(01)V9(06).

        05  H-NEW-TECH-PCT               PIC 9(01)V9(02).

  - Added new copybook, "PREV200", which contains the previous year,
    FY 2019, final wage index, by provider, per the transition
    adjustment logic accounting for changes from FY 2019 to FY 2020.

  - Added new copybook, "RATEX200", which contains the 01 level
    TB1-RATE-TABLE through TB8-RATE-TABLE. Replaces the "RATEX190"
    copybook.

  - Added new copybook, "RUFL200", which contains the rural floor wage
    index values for calculation of the rural floor for providers with
    urban CBSAs and applicable reclassification flags.

  - PPDRV200 R  2020.0 REVISED FOR RELEASE
         ** Replaces PPDRV192 **
         --------------------------------------
         Added Call PPCAL200 Using statement.

         ALPHANUMERIC STATE CODES:
         Certain states have exhausted their supply of CMS Certification
         Numbers (CCNs) for multiple provider types. New state codes
         will be assigned with alphanumeric values, instead of
         exclusively numeric values, such as:

           California  - A0 and A1    Ohio         - A6
           Florida     - A2           Pennsylvania - A7
           Louisiana   - A3           Tennessee    - A8
           Michigan    - A4           Texas        - A9
           Mississippi - A5

           + 10  W-P-STATE                PIC X(02).

           + 10  P-NEW-STATE            PIC X(02).
                 88  P-PR-NEW-STATE     VALUE '40' '84'.

           + 10  P-STATE                PIC X(02).

         RURAL FLOOR LOGIC:
         Added RUFL200 copybook and logic/variables to adjust the
         wage indices of applicable providers per new requirements
         involving providers with urban CBSAs and applicable
         reclassification flags.

           + COPY RUFL200.

           + 01  HOLD-RUFL-DATA.
                 05  RUFL-IDX2                      PIC 9(03) VALUE 0.

           + 0175-GET-RURAL-CBSA.

                 IF B-N-DISCHARGE-DATE > 20190930
                   IF H-CBSA-PROV-BLANK = '   '
                     GO TO 0175-EXIT
                   ELSE
                     PERFORM 0190-GET-RURAL-FLOOR THRU 0190-EXIT
                     GO TO 0175-EXIT
                   END-IF
                 END-IF.

           + 0190-GET-RURAL-FLOOR.

                 SET RUFL-IDX TO 1.

                 SEARCH RUFL-TAB VARYING RUFL-IDX
                 AT END
                   MOVE '   00'              TO W-RURAL-CBSA-X
                   MOVE 99999999             TO W-RURAL-CBSA-EFF-DATE
                   MOVE 0                    TO W-RURAL-CBSA-WI
                   GO TO 0190-EXIT
                 WHEN RUFL-CBSA(RUFL-IDX) = HOLD-RURAL-CBSA
                      SET RUFL-IDX2 TO RUFL-IDX.

             0190-EXIT.  EXIT.

          + IF PPS-RTC = 00
             IF W-RURAL-CBSA-EFF-DATE NOT = WS-9S
              IF B-N-DISCHARGE-DATE > 20190930
               IF H-CBSA-PROV-BLANK = '   '
                 GO TO 0690-BYPASS
               ELSE
                 PERFORM 0690-GET-RURAL-FLOOR-WAGE-INDX THRU 0690-EXIT
                 GO TO 0690-BYPASS
               END-IF
              END-IF
             END-IF
            END-IF.

          + 0690-BYPASS.

          + 0690-GET-RURAL-FLOOR-WAGE-INDX.

                IF  B-N-DISCHARGE-DATE NOT < RUFL-EFF-DATE (RUFL-IDX2)
                    RUFL-EFF-DATE (RUFL-IDX2) >= W-FY-BEGIN-DATE AND
                    RUFL-EFF-DATE (RUFL-IDX2) <= W-FY-END-DATE
                    MOVE RUFL-CBSA      (RUFL-IDX2)  TO W-RURAL-CBSA-X
                    MOVE RUFL-EFF-DATE  (RUFL-IDX2)  TO W-RURAL-CBSA-EFF
                    MOVE RUFL-WI3       (RUFL-IDX2)  TO W-RURAL-CBSA-WI.

            0690-EXIT.  EXIT.

         WAGE INDEX BOOST (QUARTILE) LOGIC:
         Added logic/variables to adjust the wage indices of applicable
         providers which are assigned a wage index below 0.8457.

           + WI_QUARTILE_FY2020       PIC 9(02)V9(04)  VALUE 0.8457.

           + IF B-N-DISCHARGE-DATE > 20190930 AND
                B-N-DISCHARGE-DATE < 20201001
                IF W-NEW-CBSA-WI < WI_QUARTILE_FY2020
                   COMPUTE W-NEW-CBSA-WI ROUNDED =
                     ((WI_QUARTILE_FY2020 - W-NEW-CBSA-WI) / 2)
                     + W-NEW-CBSA-WI.

         PREVIOUS YEAR WAGE INDEX LOGIC:
         Added PREV200 copybook and logic/variables to adjust the
         wage indices of applicable providers per the transition
         adjustment logic accounting for changes from FY19 to FY20.

           + WI_PCT_REDUC_FY2020      PIC S9(01)V9(02) VALUE -0.05.
           + WI_PCT_ADJ_FY2020        PIC 9(01)V9(02)  VALUE 0.95.

           + COPY PREV200.

           + 01  HOLD-PREV-DATA.
                 05  HLD-PREV-WI                    PIC S9(02)V9(04).

           + IF B-N-DISCHARGE-DATE > 20190930 AND
                B-N-DISCHARGE-DATE < 20201001
                PERFORM 1000-GET-PREVYR-WI THRU 1000-EXIT.

           + 1000-GET-PREVYR-WI.

                 SET PREV-IDX TO 1.

                 SEARCH PREV-TAB VARYING PREV-IDX
                 AT END
                   MOVE 52 TO PPS-RTC
                   GOBACK
                 WHEN PREV-PROV(PREV-IDX) = P-NEW-PROVIDER-NO
                   MOVE PREV-WI(PREV-IDX) TO HLD-PREV-WI.

             1000-EXIT.  EXIT.

           + IF B-N-DISCHARGE-DATE > 20190930 AND
                B-N-DISCHARGE-DATE < 20201001
                IF (((W-NEW-CBSA-WI - HLD-PREV-WI) / HLD-PREV-WI)
                      < WI_PCT_REDUC_FY2020)
                   COMPUTE W-NEW-CBSA-WI ROUNDED =
                      HLD-PREV-WI * WI_PCT_ADJ_FY2020.

  - PPCAL200 R  2020.0 REVISED FOR RELEASE
         ** Replaces PPCAL192 **
         --------------------------------------
         ALPHANUMERIC STATE CODES:
         Certain states have exhausted their supply of CMS Certification
         Numbers (CCNs) for multiple provider types. New state codes
         will be assigned with alphanumeric values, instead of
         exclusively numeric values, such as:

           California  - A0 and A1    Ohio         - A6
           Florida     - A2           Pennsylvania - A7
           Louisiana   - A3           Tennessee    - A8
           Michigan    - A4           Texas        - A9
           Mississippi - A5

           + 10  P-NEW-STATE            PIC X(02).
                 88  P-VBP-INVALID-STATE
                             VALUE '21' '80' '40' '84'.
                 88  P-READ-INVALID-STATE
                             VALUE '40' '84'.
                 88  P-HAC-INVALID-STATE
                             VALUE '40' '84'.
                 88  P-PR-NEW-STATE
                             VALUE '40' '84'.

         NEW TECHNOLOGY ADD-ON PAYMENTS:
         Revised and updated new technology add-on payment code to
         account for FY 2020 specifications.

             + Additions / Revisions / Removals for FY 2020
               - New tech codes to remove for FY 2020
                 * Defitelio
                 * Stelara
                 * Zinplava
               - New tech codes revised/continued for FY 2020
                 * AndexXa
                 * Aquabeam
                 * Giapreza
                 * Kymriah/Yescarta
                 * Plazomicin
                 * Remede System
                 * Sentinel Cerebral Protection System
                 * Vabomere
                 * Vyxeos
               - New tech codes to add for FY 2020
                 * Azedra
                 * Balversa
                 * Cablivi
                 * Elzonris
                 * Erleada
                 * Jakafi
                 * Spravato
                 * T2 Bacteria Test Panel
                 * Xospata

         Revised the universal % adjustment from 0.5 to a unique % by
         new tech code as represented by the variable H-NEW-TECH-PCT.

         COMPUTE H-LESSER-STOP-2 ROUNDED =
              (((B-CHARGES-CLAIMED * P-NEW-OPER-CSTCHG-RATIO) -
                 H-BASE-DRG-PAYMENT)) * H-NEW-TECH-PCT.
                                        **************

         RATE AND FACTOR ADJUSTMENTS:

             + Updated standardized operating and capital threshold.
               - MOVE 5796.63 TO H-OPER-BASE.
               - MOVE 462.33 TO H-CAPI-BASE.

             + Updated capital rate factors:
               - COMPUTE H-FEDERAL-RATE ROUNDED =
                      (0462.33 * H-CAPI-GAF).

             + Updated outlier threshold amount:
               - MOVE 26552.00 TO H-CST-THRESH.

             + Updated RBN and market basket factors utilized to
               calculate the overall update factor used in updating
               the HSP amount to 2020 dollars. Current five year phase
               will incorporate factors from 2019 - 2023.
               - MOVE 0.996859 TO H-BUDG-NUTR200.

               - MOVE 1.02600 TO H-UPDATE-200.

                 IF P-NEW-CBSA-HOSP-QUAL-IND = '1' AND
                    P-EHR-REDUC-IND = ' '
                    MOVE 1.02600 TO H-UPDATE-200.

                 IF P-NEW-CBSA-HOSP-QUAL-IND = '1' AND
                    P-EHR-REDUC-IND = 'Y'
                    MOVE 1.00350 TO H-UPDATE-200.

                 IF P-NEW-CBSA-HOSP-QUAL-IND = '0' AND
                    P-EHR-REDUC-IND = ' '
                    MOVE 1.01850 TO H-UPDATE-200.

                 IF P-NEW-CBSA-HOSP-QUAL-IND = '0' AND
                    P-EHR-REDUC-IND = 'Y'
                    MOVE 0.99600 TO H-UPDATE-200.

             + Updated market basket ratios for EHR savings.
               - MOVE 1.022421525 TO H-MB-RATIO-EHR-FULL.
               - MOVE 1.022590361 TO H-MB-RATIO-EHR-QUAL-FULL.

========================================================================

A partitioned data set (PDS) of the Version 2020.0 code
(MU00.@BFN2699.INNDM191) is at the CMS Data Center for users
to obtain by Connect:Direct (Network DataMover).
    **
The 47 members listed below comprise the Pricer, but only the modules
that changed since the previous release are included in the PDS. The
changed members should be used in conjunction w/ MU00.@BFN2699.INNDM192.

CMS now only sends the program modules in the release. The supporting
files and unchanged or unused program modules are no longer included in
the release. New and/or revised program modules and files will have
--- 2020.0 --- in the description column below.

NAME        DESCRIPTION
-------     ------------------------------------------------------------
CBSA200    *2020.0 FY 2020 CBSA & WAGE INDEX TABLE
DRGSX200   *2020.0 FY 2020 DRG WEIGHTS TABLE
HOUTI200   *2020.0 FY 2020 OUTMIGRATION ADJUSTMENT TABLE
MANIFEST   *2020.0 LIST OF RELEASE MEMBERS
MIDNIGHT    2017.0 TWO MIDNIGHT POLICY ADJUSTMENT FACTOR TABLE
MSAX045     2004.5 INPAT PRICING METROPOLITAN STATISTICAL AREA
NTECH200   *2020.0 FY 2020 NEW TECHNOLOGY ADD-ON VARIABLE TABLE
--------    -----------------------------------------------------------
PPCAL006    2000.6 2000 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2000
PPCAL017    2001.7 2001 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2001
PPCAL026    2002.6 2002 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2002
PPCAL038    2003.8 2003 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2003
PPCAL04D    2004.D 2004 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2004
PPCAL059    2005.9 2005 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2005
PPCAL069    2006.9 2006 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2006
PPCAL07B    2007.B 2007 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2007
PPCAL08D    2008.D 2008 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2008
PPCAL09D    2009.D 2009 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2009
PPCAL10O    2010.O 2010 INPAT CALC MODULE - CLAIMS 10/01 TO 03/31/2010
PPCAL10P    2010.P 2010 INPAT CALC MODULE - CLAIMS 04/01 TO 09/30/2010
PPCAL119    2011.9 2011 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2011
PPCAL125    2012.5 2012 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2012
PPCAL135    2013.5 2013 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2013
PPCAL14B    2014.B 2014 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2014
PPCAL156    2015.6 2015 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2015
PPCAL163    2016.3 2016 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2016
PPCAL171    2017.1 2017 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2017
PPCAL182    2018.2 2018 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2018
PPCAL192    2019.2 2019 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2019
PPCAL200   *2020.0 2020 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/2020
PPCAL884    1988.4 1988 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1988
PPCAL894    1989.4 1989 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1989
PPCAL905    1990.5 1990 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1990
PPCAL915    1991.5 1991 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1991
PPCAL926    1992.6 1992 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1992
PPCAL935    1993.5 1993 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1993
PPCAL944    1994.4 1994 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1994
PPCAL954    1995.4 1995 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1995
PPCAL964    1996.4 1996 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1996
PPCAL974    1997.4 1997 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1997
PPCAL987    1998.7 1998 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1998
PPCAL998    1999.8 1999 INPAT CALC MODULE - CLAIMS 10/01 TO 09/30/1999
--------    -----------------------------------------------------------
PPDRV200   *2020.0 2020 INPAT DRIVER MODULE
PPHOLDAR   *2020.0 PPHOLDAR-HOLD-AREA
PREV200    *2020.0 FY 2019 FINAL WAGE INDEX TABLE BY PROVIDER
RATEX200   *2020.0 FY 2020 RATES TABLE
RUFL200    *2020.0 FY 2020 CBSA & RURAL FLOOR WAGE INDEX TABLE
README     *2020.0 DESCRIPTION OF RELEASE UPDATES
