Change Request 13413 with Transmittal R12747OTN (12747) was released July 26, 2024, with an Effective Date of July 31, 2024. The document describes implementation procedures for CMS Ruling 1739-F issued June 9, 2024 which arose out of several court cases related to the SSI Fraction.
Although legal challenges to the SSI fraction are not totally resolved, CMS will allow new SSI Realignment Requests for periods prior to October 1, 2013.
CMS placed a freeze on SSI Realignment Requests a few years ago. Some submitted requests prior to or during that freeze, and those requests remain unprocessed. Hospitals will have an opportunity to confirm those requests or let them go unprocessed.
The transmittal requires MACs to send letters to providers to include a template for them to confirm an existing realignment request. If you receive a letter and have questions, contact GDS.
In most cases, in addition to not confirming prior requests, GDS is recommending providers hold off on new SSI Realignment Requests considering the Advocate Christ SSI case soon to be before the Supreme Court. This challenge had considerable validity when filed and the recent overturning of Chevron by SCOTUS and the SCOTUS decision in Empire may handcuff the court in the Advocate Christ SSI case on how it interprets "entitled to SSI benefits" to one that is favorable to hospitals.
The transmittal also details how the MAC will hold SSI Realignment Requests in three situations prior to CMS deciding whether to process them:
- The cost report begin and/or end date in the provider’s request does not match the information in the cost reporting period SSI ratio files on the CMS DSH website.
- The provider requests a realignment for a cost reporting period that includes discharges from prior to October 1, 2004, and is not subject to CMS Ruling 1498-R.
- The provider requests a realignment for a cost reporting period that is subject to a settlement agreement in which the parties agreed that the SSI ratio determined under the settlement be final.
One theory why CMS is holding request for hospitals not subject to CMS Ruling 1498-R is that CMS may only have access to data limited to the enhanced match under Baystate and Ruling 1498-R to which providers would benefit if allowed to request realignments even though their cost reports may not have been open, had an active appeal on the issue, or been a party to the Baystate case. So, parties that would seem to be precluded from that enhanced match will have access unless the situation is addressed. This would be unfair to hospitals that had a realignment prior to the enhanced match affecting the data.
CMS has also posted revised SSI percentages for each year per Ruling 1739-R. CMS has tightened up the process used to obtain patient level data to include the involvement of the provider.
If you have questions about SSI realignments, available data, the types of data, why some realignment requests should be canceled, possible case law developing from this transmittal, or how case law may impact your provider, contact
adamblackwell@govdataservices.com to set up a complimentary discussion.
Change Request 13413 can be found at this link: