U.S. Department of Health and Human Services
Health Care Financing Administration

Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1994 Rates; Proposed Rule

The Federal Bulletin Board File: 58F30221.EXE


This compressed file contains the 43 files comprising the source documents for the "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1994 Rates; Proposed Rule" that appears in the FEDERAL REGISTER, Volume 58, Number 100, Part II (May 26, 1993), beginning on page 30221.

The printed copy in the FEDERAL REGISTER of May 26, 1993 is the official version of this proposed rule. Every effort has been made to ensure that the files on The Federal Bulletin Board accurately reflect the proposed rule as published in the FEDERAL REGISTER; however, in the case of a discrepancy, the published proposed rule takes precedence. The published version also allows anyone using these files to see how the complete document is assembled.

To order copies of the FEDERAL REGISTER containing this document, send your request to:  New Orders, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA  15250-7954.  Specify the date of the issue requested and enclose a check or money order payable to the Superintendent of Documents, or enclose your Visa or Master Card number and expiration date.  Credit card orders can also be placed by calling the order desk at (202) 783-3238 or by faxing to (202) 275-6802.  The cost for each copy is $4.50. 

All 43 files and this documentation file (58F30221.DOC) have been compressed into a single, self-executing file named 58F30221.EXE using the software PKZIP from PKWARE, Inc.  To extract the files, create a subdirectory on your hard disk, change to that subdirectory and then type [path name] 58F30221 and enter. The path name should specify the subdirectory where your communications software places downloaded files. You will need 2.6 megabytes available on the hard disk for the decompressed files.  For example, if your hard disk is drive C and the file 58F30221.EXE is in a subdirectory called COMM, you would type the  commands as shown below:

To create a directory named HCFA:
     C:>  MKDIR HCFA {enter}
To move to the HCFA directory:
     C:>  CD HCFA {enter}
To extract the compressed files in the COMM directory and move them to the HCFA directory:
     C:\HCFA>  C:\COMM\58F30221 {enter}


When extracted, your HCFA directory will contain 44 files; the 43 source files for the proposed rule and a copy of this documentation file, 58F30221.DOC. The files are in two different formats, ASCII and WordPerfect 5.0. The WordPerfect files are marked with the extension .WP and the ASCII files have the extension .DOC or .TXT

The complete list of source files is as follows:

	58F30221.DOC		TABLE04D.WP		TABLE09.TXT
	PRORULE1.WP		TABLE04E.WP		TABLE10.WP
	PRORULE2.WP		TABLE05.TXT		APP_A.WP
	PRORULE3.WP		TABLE06A.WP		APP_AT1.WP
	PRORULE4.WP		TABLE06B.WP		APP_AT2.WP
	PRORULE5.WP		TABLE06C.WP		APP_AT3.WP
	PRORULE6.WP		TABLE06D.WP		APP_AT5.WP
	PRORULE7.WP		TABLE06E.WP		APP_AT7.WP
	ADDENDUM.WP		TABLE06F.WP		APP_B.WP
	TABLIST.WP		TABLE06G.WP		APP_C.WP
	TABLE01.WP		TABLE06H.WP		APP_D.WP
	TABLE03.TXT		TABLE07A.TXT		APP_E.WP
	TABLE04A.WP		TABLE07B.TXT		APP_F.TXT
	TABLE04B.WP		TABLE08A.WP		APP_G.WP
	TABLE04C.WP		TABLE08B.WP

The text and preamble of the proposed rule, "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1994 Rates", is contained in seven separate WordPerfect files, PRORULE1.WP through PRORULE7.WP. The text for the addendum to this proposed rule, "Addendum - Proposed Schedule of Standardized Amounts Effective with Discharges on or after October 1, 1993 and Update Factors and Rate-of-Increase Percentages Effective with Cost Reporting Periods Beginning on or after October 1, 1993", is contained in the file named "ADDENDUM.WP." 

The file named "TABLIST.WP" contains a listing of the tables referred to in the preamble, text, and addendum to the proposed rule. These tables were printed in the FEDERAL REGISTER of May 26, 1993 and are contained in the files, Table01 through Table10. Some of these tables are in ASCII text format as indicated by the extension .TXT and others are in WordPerfect, extension .WP. A list of these tables and the files that contains them follows:

	TABLE								FILE NAME

Table 1a--National Adjusted Operating			TABLE01.WP
	Standardized Amounts, Labor/Nonlabor

Table 1c--Adjusted Operating Standardized		TABLE01.WP
	Amounts for Puerto Rico, Labor/Nonlabor

Table 1d--Capital Standard Federal Payment		TABLE01.WP
	Rate

Table 3C--Hospital Case Mix Indexes for			TABLE03.TXT
	Discharges Occurring in Federal Fiscal
	Year 1992

Table 4a--Wage Index and Capital Geographic		TABLE04A.WP
	Adjustment Factor (GAF) for Urban Areas
Table 4b--Wage Index and Capital Geographic		TABLE04B.WP
	Adjustment Factor (GAF) for Rural Areas

Table 4c--Wage Index and Capital Geographic		TABLE04C.WP
	Adjustment Factor (GAF) for Hospitals
	That Are Reclassified

Table 4d--Average Hourly Wage for Urban Areas	TABLE04D.WP

Table 4e--Average Hourly Wage for Rural Areas	TABLE04E.WP

Table 5--List of Diagnosis Related Groups		TABLE05.TXT
	(DRGs), Relative Weighting Factors,
	Geometric Mean Length of Stay, and Length
	of Stay Outlier Cutoff Points Used in the
	Prospective Payment System

Table 6a--New Diagnosis Codes					TABLE06A.WP

Table 6b--New Procedure Codes					TABLE06B.WP

Table 6c--Invalid Diagnosis Codes 				TABLE06C.WP

Table 6d--Revised Diagnosis Code Titles			TABLE06D.WP

Table 6e--Revised Procedure Code Titles			TABLE06E.WP

Table 6f--Additions to the CC Exclusions List	TABLE06F.WP

Table 6g--Deletions to the CC Exclusions List	TABLE06G.WP

Table 6h--Additional OR Procedures That Group	TABLE06H.WP
	to DRG 477

Table 7A--Medicare Prospective Payment System	TABLE07A.TXT
	Selected Percentile Lengths of Stay FY 92
	MEDPAR Update 12/92 GROUPER V 10.0

Table 7B--Medicare Prospective Payment System	TABLE07B.TXT
	Selected Percentile Lengths of Stay FY 92
	MEDPAR Update 12/92 GROUPER V 11.0

Table 8a--Statewide Average Operating			TABLE08A.WP
	Cost-to-Charge Ratios for Urban and Rural
	Hospitals (Case Weighted) April 1993

Table 8b--Statewide Average Capital			TABLE08B.WP
	Cost-to-Charge Ratios for Urban and Rural
	Hospitals (Case Weighted) April 1993

Table 9--1992 Transfer Adjusted Case-Mix Index	TABLE09.TXT
	and Transfer Adjustment to Discharges for
	Capital Hospital-Specific Rate
	Redeterminations

Table 10--Percentage Difference in Wage Indexes	TABLE10.WP
	for Areas That Qualify for a Wage Index
	Exception for Excluded Hospitals and Units


The text and some of the tables for "Appendix A - Regulatory Impact Analysis" are contained in the file named "APP_A.WP." In addition to this file, there are six additional Appendix A tables contained in the files APP_AT1.WP, APP_AT2.WP, APP_AT3.WP, APP_AT5.WP, AND APP_AT7.WP. The main file, APP_A.WP, is marked to indicate where these addition tables should be inserted in the text. Note that file APP_AT5.WP contains two separate tables.

A list of the remaining appendixes, Appendix B through Appendix G, and the files that contain them follows:

	APPENDIX								FILE NAME

Appendix B - Technical Appendix on the Capital	APP_B.WP
	Acquisition Model and Budget Neutrality
	Adjustment

Appendix C - (Letters to Congress on recommended	APP_C.WP
	increases to the Medicare prospective
	payment schedule)

Appendix D - Recommendation of Update Factors	APP_D.WP
	for Operating Cost Rates of Payment for
	Inpatient Hospital Services

Appendix E - Development of Update Framework for	APP_E.WP
	Prospective Payment System for Inpatient
	Hospital Capital-Related Costs

Appendix F - PROPAC Proposed Nearest Neighbor	APP_F.TXT
	Wage Index (table in ASCII text format)

Appendix G - Prospective Payment Assessment 		APP_G.WP
	Commission; Report and Recommendations
	to the Congress

The file for Appendix G contains the full text and tabular data published in the FEDERAL REGISTER, but does not contain the graphic figures.


This proposed rule is being disseminated on the Federal Bulletin Board to facilitate its use by the public. Both the Health Care Financing Administration (HCFA) and the Government Printing Office (GPO) are interested in receiving comments on the usefulness of the material in its present machine-readable form and suggestions for future enhancements.

Your comments should be addressed to:

	Office of Electronic Information Dissemination Services
	Mail Stop SDE
	U.S. Government Printing Office
	Washington, DC 20401

	Telephone: (202) 512-1525
	FAX:       (202) 512-1262

For further information concerning the content of this notice, contact:

	Barbara Wynn
	Health Care Financing Administration
	(410) 966-4529