CMS issued CMS Ruling 1498-R2 on April 22, 2015 concerning SSI ratios for periods before October 1, 2004. In addition, CMS also posted revised SSI ratios in accordance with the terms of the ruling.
CMS Ruling 1498-R was originally issued in 2010 as a result of the court’s decision in the Baystate case. Generally, the ruling called for the recalculation of SSI ratios for open cost reports and for properly pending Disproportionate Share Hospital (DSH) appeals on the Baystate issue, in accordance with the court’s ruling in that case. However, also included was a provision to incorporate into the revised ratios non-covered Part A days, which was contrary to CMS’ policy and practice during those years.
This ruling, CMS Ruling 1498-R2, articulates that CMS will settle DSH cases using the higher of the following calculated ratios:
FFY Covered Days/Part A Covered Days
FFY LOS Days/Part A LOS Days
Hosp. FY Covered Days/Part A Covered Days
Hosp. FY LOS Days/Part A LOS Days
At this point there is nothing additional for our clients to do as we are working with CMS and the lawyers to navigate through not only the SSI ratio calculation choices but the underlying data questions we have as well (data used to compute the revised ratios as well as the process being used). We expect that process to continue for some time. However, if based on the issuance of this ruling questions arise regarding your specific appeals, please do not hesitate to contact SCA.
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