--- title: "CMS Ruling 1498-R3: A Partially Murky Resolution of SSI Ratio's Sordid History" description: On April 10, 2023, CMS issued the Federal Fiscal Year 2024 Inpatient Prospective Payment System Proposed Rule. image: https://public.govdataservices.com/hubfs/Hand%20about%20to%20bang%20gavel%20on%20sounding%20block%20in%20the%20court%20room-1.jpeg --- [Skip to content](https://public.govdataservices.com/the-scoop/cms-ruling-1498-r3-a-partially-murky-resolution-of-ssi-ratios-sordid-history#main-content) Close - [Services](https://public.govdataservices.com/services-page) - [Medicare DSH](https://public.govdataservices.com/medicare-dsh) - [SSI Realignment](https://govdataservices-21378692.hs-sites.com/medicare-dsh#SSI) - [340B MA Underpayments](https://public.govdataservices.com/340b-medicare-advantage-underpayments) - [Medicare Bad Debt](https://public.govdataservices.com/medicare-bad-debt) - [Worksheet S-10 Uncompensated Care](https://public.govdataservices.com/s-10) - [Transfer DRG](https://public.govdataservices.com/transfer-drg) - [Medicare ID & Shadow Billing](https://public.govdataservices.com/medicare-id-shadow-billing) - [MBI ID Finder](https://public.govdataservices.com/mbi-id-finder) - [MIDaS Insurance ID](https://public.govdataservices.com/midas-insurance-id) - [Annual Wellness Visit](https://public.govdataservices.com/annual-wellness-visit) - [Eligibility & Other Services](https://public.govdataservices.com/eligibility-and-other) - [Bundle & Save](https://public.govdataservices.com/bundle-and-save) - [Demo](https://public.govdataservices.com/demo-diagnostics-review) - Resources - [Links](https://public.govdataservices.com/links) - [Blog](https://public.govdataservices.com/the-scoop) - [Contact Us](https://public.govdataservices.com/contact-us) SEARCH [Client Login](https://www.govdataservices.com/gdswebsite/DesktopDefault.aspx) [![GDSlogo\_avenir\_2](https://public.govdataservices.com/hs-fs/hubfs/GDSlogo_avenir_2.png?width=1194&height=340&name=GDSlogo_avenir_2.png)](https://public.govdataservices.com/) - [Services](https://public.govdataservices.com/services-page) - [Medicare DSH](https://public.govdataservices.com/medicare-dsh) - [SSI Realignment](https://govdataservices-21378692.hs-sites.com/medicare-dsh#SSI) - [340B MA Underpayments](https://public.govdataservices.com/340b-medicare-advantage-underpayments) - [Medicare Bad Debt](https://public.govdataservices.com/medicare-bad-debt) - [Worksheet S-10 Uncompensated Care](https://public.govdataservices.com/s-10) - [Transfer DRG](https://public.govdataservices.com/transfer-drg) - [Medicare ID & Shadow Billing](https://public.govdataservices.com/medicare-id-shadow-billing) - [MBI ID Finder](https://public.govdataservices.com/mbi-id-finder) - [MIDaS Insurance ID](https://public.govdataservices.com/midas-insurance-id) - [Annual Wellness Visit](https://public.govdataservices.com/annual-wellness-visit) - [Eligibility & Other Services](https://public.govdataservices.com/eligibility-and-other) - [Bundle & Save](https://public.govdataservices.com/bundle-and-save) - [Demo](https://public.govdataservices.com/demo-diagnostics-review) - Resources - [Links](https://public.govdataservices.com/links) - [Blog](https://public.govdataservices.com/the-scoop) - [Contact Us](https://public.govdataservices.com/contact-us) [Client Login](https://www.govdataservices.com/gdswebsite/DesktopDefault.aspx) [Chris Cusimano](https://public.govdataservices.com/the-scoop/author/chris-cusimano) Jun 4, 2024, 12:13:17 PM 2 min read # CMS Ruling 1498-R3: A Partially Murky Resolution of SSI Ratio's Sordid History [Previous](https://public.govdataservices.com/the-scoop/ffy-2025-ipps-proposed-rule-on-display-today) [Next](https://public.govdataservices.com/the-scoop/scotus-grants-writ-of-certiorari-to-hear-advocate-christ-case) The SSI ratio is a critical factor in determining the amount of Medicare DSH Reimbursement.    CMS Ruling 1498-R3 (dated March 3, 2024) revoked CMS Ruling 1498-R2 (dated April 22, 2010) and provided additional guidance ( [cms-1498-r3.pdf](https://www.cms.gov/files/document/cms-1498-r3.pdf) ). Ruling 1498-R2 gave providers rights to choose between what are generally referred to as Covered Days or Total Days in the calculation of the SSI ratio for their hospital. ( [cms1498-r2.pdf](https://www.cms.gov/regulations-and-guidance/guidance/rulings/downloads/cms1498-r2.pdf) ).   Central to Covered Days and Total Days was the Becerra v. Empire Health Foundation Supreme Court Case decided along a 5-4 vote as decided June 24, 2022 ( [20-1312\_j42l.pdf (supremecourt.gov)](https://www.supremecourt.gov/opinions/21pdf/20-1312_j42l.pdf). Ruling 1498-R3 was noted by CMS as being necessary to comply with the June 24, 2022 ruling.    The nuances of Ruling 1498-R3 and the Supreme Court case fundamentally address the concepts of patients who exhausted their Medicare Part A benefits and the non-covered Medicare Part A patient days.   The ***specifics*** of SSI strategies, of 1498-R3, and of the circumstances under which negative adjustments may be proposed are very important.    As one example, providers should not conclude or accept at face value negative proposed adjustments. Ruling 1498-R3 notes specifically that providers have a right to appeal the damaging effects of 1498-R3. GDS believes there are a few possible developing scenarios and potential stances for appeal and litigation.    Providers should take note of specifically what falls under 1498-R3. Providers should not conclude at this time that everything prior to October 1, 2004 falls under 1498-R3. GDS believes there are considerations for potential appeal and litigation if CMS is not forthcoming with additional guidance.   One clear take away is that for open cost reports and "appeals" (written in 1498-R3 as "DSH appeal", "pending appeals", "pending administrative appeals", "appealed cost reports", "properly pending appealed") the use of Total Days is mandated.   Contact Adam Blackwell at [adamblackwell@govdataservices.com](mailto:adamblackwell@govdataservices.com) to further discuss strategies pertaining to SSI realignment, SSI ratio settlements, and Medicare DSH. ![avatar](https://public.govdataservices.com/hs-fs/hubfs/chriscusimano.jpg?width=290&name=chriscusimano.jpg) #### [Chris Cusimano](https://public.govdataservices.com/the-scoop/author/chris-cusimano) ## RELATED ARTICLES ### [Chris Cusimano Feb 24, 2023, 3:00:00 PM \< 1 min read FFY 2021 SSI File for IPPS hospitals Today, February 24, 2023, CMS released the FFY 2021 SSI File for IPPS hospitals. This is the value to be used in the Medicare ... Start Reading](https://public.govdataservices.com/the-scoop/ffy-2021-ssi-file-for-ipps-hospitals) ### [Chris Cusimano Apr 29, 2025, 1:05:20 PM 2 min read SCOTUS: No Provider Relief, SSI Days Must be those Receiving Payment Today, the Supreme Court of the United States (SCOTUS) affirmed the D.C. Circuit’s decision in Advocate Christ Medical Center ... Start Reading](https://public.govdataservices.com/the-scoop/scotus-ssi-days-must-be-those-receiving-payment) ### [Chris Cusimano Apr 10, 2023, 4:15:00 PM \< 1 min read CMS Releases FFY 2024 IPPS Proposed Rule On April 10, 2023, CMS issued the Federal Fiscal Year 2024 Inpatient Prospective Payment System Proposed Rule. Start Reading](https://public.govdataservices.com/the-scoop/ffy-2024-ipps-proposed-rule) [![gds-logo-1](https://public.govdataservices.com/hs-fs/hubfs/gds-logo-1.png?width=500&height=150&name=gds-logo-1.png)](https://public.govdataservices.com/) **Get in Touch** Government Data Services 3200 W. Market St., Ste. 102 Akron, OH 44333-3324 Government Data Services 117 Seaboard Lane, F270 Franklin, TN 37067 Toll Free: (800) 370-7397 Email: [info@govdataservices.com](mailto:info@govdataservices.com) ![soc](https://public.govdataservices.com/hs-fs/hubfs/soc.jpg?width=44&name=soc.jpg)[![digicert](https://public.govdataservices.com/hs-fs/hubfs/digicert.png?width=117&name=digicert.png)](https://seal.digicert.com/seals/popup/?tag=VtfrmabA&url=www.govdataservices.com) © 2026 - Government Data Services LLC. All rights reserved - [Site Use Agreement](https://public.govdataservices.com/terms-of-use) - [Confidentiality and Privacy](https://public.govdataservices.com/privacy) ```json { "@context" : "http://schema.org", "@type" : "Organization", "knowsLanguage" : "en", "name" : "", "url" : "https://public.govdataservices.com/the-scoop/cms-ruling-1498-r3-a-partially-murky-resolution-of-ssi-ratios-sordid-history" } ``` ```json { "@context" : "http://schema.org", "@type" : "BlogPosting", "abstract" : "On April 10, 2023, CMS issued the Federal Fiscal Year 2024 Inpatient Prospective Payment System Proposed Rule.", "author" : { "@type" : "Person", "name" : "Chris Cusimano" }, "dateModified" : "June 4, 2024 4 PM", "datePublished" : "June 4, 2024 4 PM", "headline" : "CMS Ruling 1498-R3: A Partially Murky Resolution of SSI Ratio's Sordid History", "image" : "https://21378692.fs1.hubspotusercontent-na1.net/hubfs/21378692/Hand%20about%20to%20bang%20gavel%20on%20sounding%20block%20in%20the%20court%20room-1.jpeg", "inLanguage" : "en", "keywords" : "[Legal News, Medicare Cost Report, Inpatient Prospective Payment System, SSI]", "mainEntityOfPage" : { "@type" : "WebPage" }, "name" : "CMS Ruling 1498-R3: A Partially Murky Resolution of SSI Ratio's Sordid History", "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "" }, "name" : "" }, "text" : "The SSI ratio is a critical factor in determining the amount of Medicare DSH Reimbursement. CMS Ruling 1498-R3 (dated March 3, 2024) revoked CMS Ruling 1498-R2 (dated April 22, 2010) and provided additional guidance ( cms-1498-r3.pdf ). Ruling 1498-R2 gave providers rights to choose between what are generally referred to as Covered Days or Total Days in the calculation of the SSI ratio for their hospital. ( cms1498-r2.pdf ). Central to Covered Days and Total Days was the Becerra v. Empire Health Foundation Supreme Court Case decided along a 5-4 vote as decided June 24, 2022 ( 20-1312_j42l.pdf (supremecourt.gov). Ruling 1498-R3 was noted by CMS as being necessary to comply with the June 24, 2022 ruling. The nuances of Ruling 1498-R3 and the Supreme Court case fundamentally address the concepts of patients who exhausted their Medicare Part A benefits and the non-covered Medicare Part A patient days. The specifics of SSI strategies, of 1498-R3, and of the circumstances under which negative adjustments may be proposed are very important. As one example, providers should not conclude or accept at face value negative proposed adjustments. Ruling 1498-R3 notes specifically that providers have a right to appeal the damaging effects of 1498-R3. GDS believes there are a few possible developing scenarios and potential stances for appeal and litigation. Providers should take note of specifically what falls under 1498-R3. Providers should not conclude at this time that everything prior to October 1, 2004 falls under 1498-R3. GDS believes there are considerations for potential appeal and litigation if CMS is not forthcoming with additional guidance. One clear take away is that for open cost reports and \"appeals\" (written in 1498-R3 as \"DSH appeal\", \"pending appeals\", \"pending administrative appeals\", \"appealed cost reports\", \"properly pending appealed\") the use of Total Days is mandated. Contact Adam Blackwell at adamblackwell@govdataservices.com to further discuss strategies pertaining to SSI realignment, SSI ratio settlements, and Medicare DSH.", "url" : "https://public.govdataservices.com/the-scoop/cms-ruling-1498-r3-a-partially-murky-resolution-of-ssi-ratios-sordid-history", "wordCount" : "596" } ``` ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Chris Cusimano", "url" : "https://public.govdataservices.com/the-scoop/author/chris-cusimano" }, "dateModified" : "2024-06-04T16:27:18.897Z", "datePublished" : "2024-06-04T16:13:17.000Z", "headline" : "CMS Ruling 1498-R3: A Partially Murky Resolution of SSI Ratio's Sordid History", "image" : [ "https://public.govdataservices.com/hubfs/Hand%20about%20to%20bang%20gavel%20on%20sounding%20block%20in%20the%20court%20room-1.jpeg" ], "mainEntityOfPage" : { "@id" : "https://public.govdataservices.com/the-scoop/cms-ruling-1498-r3-a-partially-murky-resolution-of-ssi-ratios-sordid-history", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject" } } } ```