On July 5, 2012, CMS released a new MLN Matters article: “The Supplemental Security Income (SSI) Ratios for Fiscal Year (FY) 2006 through FY 2009 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs).” The article informs IPPS hospitals, IRFs, and LTCHs that CMS has provided the SSI Ratios for FYs 2006 through 2009 on its website. The article notes that these SSI ratios include Medicare Advantage (MA) patient days. In addition, the article reminds providers that the SSI ratios are calculated pursuant to the method set forth in the CMS Ruling CMS-1498-R, which became effective on April 28, 2010. The inclusion of MA patient days and non-covered Medicare days in the SSI Ratio has been the subject of a great deal of controversy based on arguments that the Medicare Disproportionate Share (DSH) statute does not support the inclusion of such days in the SSI ratio.
As provided in the article, the IPPS SSI ratios are located on the CMS website here and are used to calculate the Medicare DSH payments for settlement of cost reports. The IRF SSI ratios, which are used as part of a formula to estimate the payment adjustment for low income patients, are located here. The LTCH SSI ratios, located here, are used for purposes of the payment adjustment for short-stay outlier cases which, as provided in 42 C.F.R. § 529(d)(4), requires the calculation of an amount comparable to the hospital IPPS per diem amount.
The article encourages providers who wish to obtain the data used to calculate their SSI ratios for FYs 2006 through 2009 to follow CMS’s data request process and submit a Letter of Request and a DSH Data Use Agreement. The article also notifies providers that previously submitted requests for realignment of SSI ratios based on the cost reporting periods for IPPS payments will need to be resubmitted because the SSI ratios have been revised. Obtaining this data may be very important for hospitals seeking to challenge CMS’s controversial SSI ratio policy. Finally, the article notes that over the next year, Medicare contractors are anticipated to settle the backlog of cost reports that were pending while awaiting release of the revised SSI ratios.
The MLN Matters article can be found here.
Reporter, Jennifer Simmen Lewin, Atlanta, +1 404 572 3569, jlewin@kslaw.com.
