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Last Modified: 10/2/2020 Location: FL, PR, USVI Business: Part A

Instructions for FY 2004 and earlier SSI ratios and patient discharges before October 1, 2004

Change request (CR) 9896 states that a provider may elect whether to receive a suitably revised Medicare-Supplemental Security Income (SSI) fraction on the basis of “covered days” or “total days” for hospital cost reporting periods that involve SSI ratios for federal fiscal year 2004 and earlier, or SSI ratios for hospital cost reporting periods, but only for those patient discharges occurring before October 1, 2004. This election is available for hospital cost reporting periods where the Medicare contractor has not yet settled the provider’s Medicare cost report, as well as appeals remanded to the contractor pursuant to Centers for Medicare & Medicaid Services (CMS) ruling 1498-R (assuming any such hospital cost reporting period involves SSI ratios for federal fiscal year 2004 and earlier or SSI ratios for hospital cost reporting periods, but only for those patient discharges occurring before October 1, 2004). The election is also available for hospital cost reporting periods previously reopened specifically for the Medicare-SSI fraction issue. Neither CMS ruling 1498-R nor the amendment in CMS ruling 1498-R2 required reopening.
However, 42 CFR 412.106(b)(3) allows hospitals the opportunity to request to have their Medicare-SSI fraction realigned based on their cost reporting period (as opposed to the federal fiscal year). Therefore, if a hospital wishes to review its patient level data to determine if it wants to elect a realigned Medicare-SSI fraction, the hospital shall notify First Coast Service Options within 30 days of this article posting so that issuance of an Notice of Program Reimbursement (NPR)/revised NPR with a revised Medicare-SSI fraction calculated based on the federal fiscal year is placed on hold. In addition, the hospital shall notify First Coast within 180 calendar days of its request to place the cost report on hold as to whether it wants to (a) submit a request for a realigned Medicare-SSI fraction or (b) settle the cost report with a revised Medicare-SSI fraction based on the federal fiscal year. If a hospital fails to meet this deadline, First Coast shall issue an NPR/revised NPR based on the higher (total or covered) of the federal fiscal years’ ratios for that hospital using the fiscal year ratios from the CMS website for the relevant fiscal year(s). The provider may subsequently request realignment using normal timelines and procedures.
In addition, if a hospital previously received an initial NPR/revised NPR with a revised Medicare-SSI fraction calculated based on the federal fiscal year, the hospital may request realignment, based on the revised Medicare-SSI fraction, within the normal timeframes.
The official instruction, CR10484, issued by CMS regarding this change can be found here external link.
Please submit all elections to PRRBAppeals@fcso.com.
Source: CR 10484
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