FY 2020 Wage Index Alternatives Considered Public Use File (PUF)		
"(note, wage index values included in this file are prior to the proposed application of a transition cap on decreases)"		
"FY 2020 Proposal, Alternative #1 (Alt #1) and Alternative #2 (Alt #2)"		
Provider Number	6 digit Medicare provider number; the first 2 digits are the state code.	
CASETA37	Transfer Adjusted Cases under Grouper V37 and FY 2020 Post-Acute Transfer Policy	
TACMIV37	Transfer adjusted Case Mix Index under Grouper V37 and FY 2020 Post-Acute Transfer Policy	
FY 2019 Wage Index	"FY 2019 wage index after applying the MGCRB reclassifications, rural floor, adjustments for the Frontier wage index provision and the P.L. 108-173 Sec 505 adjustments where applicable for FY 2019. Wage Index reflects the application of national rural floor budget neutrality required under the Affordable Care Act."	
FY 2020 Wage Index - Proposed	"As described more fully in section III.N.3.b. of the preamble of the proposed rule, we are proposing to maintain budget neutrality for our proposal to increase the wage index for hospitals with wage index values below the 25th percentile wage index value (that is, low wage index hospitals) by reducing the wage index of hospitals with wage index values above the 75th percentile wage index value (that is, high wage index hospitals).  Specifically, as described in section III.N.3.b. of this proposed rule, we are proposing to implement budget neutrality by reducing the distance between the otherwise applicable wage index for high wage index hospitals and the 75th percentile wage index across all hospitals.  "	
FY 2020 Wage Index - Alternative Considered #1	"As an alternative to our proposed budget neutrality approach, we considered applying a budget neutrality factor to the standardized amount rather than focusing the adjustment on the wage index of high wage index hospitals.  This alternative approach would have been similar to the budget neutrality approach proposed for the transition, as described more fully in section III.N.3.d. of the preamble of the proposed rule."	
FY 2020 Wage Index - Alternative Considered #2	"As another alternative to addressing wage index disparities, we also considered mirroring our proposed approach of raising the wage index for low wage index hospitals in reducing the wage index values for high wage index hospitals.  As described more fully in section III.N.3.a. of the preamble of this proposed rule, we are proposing to increase the wage index for hospitals with a wage index below the 25th percentile wage index.  The proposed increase in the wage index for these hospitals would be equal to half the difference between the otherwise applicable final wage index value for these hospitals and the 25th percentile wage index value.  Under the alternative considered, we also would decrease the wage index for hospitals with a wage index above the 75th percentile wage index by half the difference between the otherwise applicable final wage index value for these hospitals and the 75th percentile wage index value.  We would make the estimated net effect on payments of (1) the increase in the wage index for hospitals below the 25th percentile and (2) the decrease in the wage index for hospitals above the 75th percentile budget neutral through an adjustment to the standardized amount."	
		
Alternative #3 (Alt #3)		
FY 2020 Wage Index - Alternative Considered #3	"A third alternative we considered to address wage index disparities was the creation of a national rural wage index area.  We considered whether there currently exists a national rural labor market for hospital labor and, if not, whether we should facilitate the creation of such a national rural labor market through the establishment of this national rural wage index area.  Currently, we use statewide rural wage index areas based on the non-MSA area of each State.  Under the alternative we considered, we would create a single national rural wage index area.  A single national rural wage index area and rural wage index value would arguably partially address wage index disparities because the current rural area in each State with a wage index value below the national rural wage index value would rise to the national rural wage index value.  A national rural labor market area would also act to mitigate the incentives to manipulate the rural floor because the effect of such manipulations on the rural average hourly wage would be spread across the national rural wage index area rather than targeted in a single State.  However, it should also be noted that the establishment of a national rural wage index area would have a negative impact on hospitals in the rural areas in States with current rural wage index values above the national rural wage index value because these current wage index values would decline to the national rural wage index value.  We note that the estimated value for a national rural floor wage index is 0.8569.  Due to the uniform nature of this alternative we have provided comparison information to the rural FY 2019 wage index values for each State in the ""Alternative #3"" tab rather than by hospital as we did for Alternative #1 and Alternative #2.  The FY 2019 wage index information on this tab is also available on the CMS website at this link:  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Final-Rule-Home-Page-Items/FY2019-IPPS-Final-Rule-Tables.html "	
		
		
		
		
		
		
		
		
		
		
		
		
		
		
		
		
