CMS Issues DSH Ruling on SSI Fraction, Non-Covered Days, Labor/Delivery Days - May 11, 2010

On April 28, the Centers for Medicare and Medicaid Services (CMS) issued a ruling, effective immediately, on three issues related to the calculation of the Medicare disproportionate share hospital (DSH) payment adjustment. First, with respect to the Medicare fraction of the Medicare DSH patient percentage calculation, CMS will use the data matching process for determining Supplemental Security Income (SSI) eligibility included in the final inpatient prospective payment system rule for FY 2011. Second, for the period before October 1, 2004, non-covered days for eligible Medicare Part A beneficiaries will be included in the calculation of SSI ratios, regardless of whether or not hospital benefits were exhausted. Finally, labor and delivery days before October 1, 2009, will be included in the Medicaid fraction. The ruling applies to open cost reports and appeals before the Provider Reimbursement Review Board and other Medicare administrative appeals tribunals, which must remand pending claims to the Medicare administrative contractors for recalculation under the new ruling.