On July 26, 2024, CMS issued Change Request (CR) No. 13413 providing instructions and timelines for Medicare Administrative Contractors (MACs) for the processing of SSI realignment requests for cost reporting periods before October 1, 2013. This CR comes after a several-year moratorium on the processing of such requests which was in place pending CMS’s adoption of a final rule regarding the treatment of Medicare Part C days in providers’ Medicare Disproportionate Share Hospital (DSH) calculation.
Earlier this year in February 2024, CMS published Transmittal 12513 for CR 13294 to issue guidance to MACs on the treatment of Medicare Part C days in providers’ calculation of their Medicare DSH adjustment effective March 25, 2024. The CR contained instructions for MACs to implement the requirements of the CMS-1739-F “Medicare Part C Days in the Calculation of a Hospital’s Medicare Disproportionate Patient Percentage” final rule published on June 9, 2023. That rule finalized CMS’s proposal that a patient enrolled in a Medicare Advantage plan remains entitled to benefits under Medicare Part A and will be counted in the DSH Medicare fraction and not counted in the numerator of the Medicaid fraction for cost reporting periods that include discharges before October 1, 2013. That transmittal concluded the multi-year moratorium in which MACs have held settlements for cost years affected by the Allina litigation. However, Change Request 13294 was silent on the question of how CMS will address timelines for resolving outstanding SSI realignment requests. Under 42 C.F.R. 412.106(b)(3), hospitals may submit a written request to CMS through their MAC to use the hospital’s cost reporting period instead of the Federal fiscal year. This request includes the hospital’s name, provider number, and cost reporting period end date.
Now, CMS has announced that the federal fiscal year SSI ratios available on the CMS DSH website for cost reporting periods starting before October 1, 2013, have been determined pursuant to CMS-1739-F, issued June 9, 2023, using the data available to CMS. CMS explained that for realignment requests for cost reporting periods starting before FY 2014, CMS will calculate cost reporting period SSI ratios for all periods and for all hospitals. CMS will make available these ratios on the CMS DSH website. CMS instructs the MACs to use these cost reporting period SSI ratios to determine hospitals’ DSH payments for realignment requests.
CMS has instructed MACS to send hospitals they service a notification letter that the cost reporting period SSI rations have been posted and ask hospitals to confirm any realignment requests for the cost reporting periods before FY 2014. The MAC’s notification letter also has instructions for new realignment requests as hospitals may submit realignment requests for cost reporting periods beginning prior to October 1, 2013, at any time in accordance with CMS realignment request policy. While this CR signals a step forward, it affords MACs a generous timeline of 24 months to issue new NPRs after receiving confirmation of existing or new realignment requests.
The CMS Transmittal can be accessed here.
The CMS DSH website can be accessed here.
