--- title: U.S. Court of Appeals for the D.C. Circuit Decides SSI Case description: The Court of Appeals reversed a prior District Court decision that had allowed providers to appeal their SSI ratios before the issuance of a Notice of Program Reimbursement (NPR) on finalized cost reports. image: https://public.govdataservices.com/hubfs/Doctor%20working%20with%20digital%20tablet%20and%20laptop%20computer%20in%20medical%20workspace%20office%20and%20overcast%20exposure%20effect.jpeg --- [Skip to content](https://public.govdataservices.com/the-scoop/us-court-of-appeals-for-the-dc-circuit-decides-ssi-case#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) Sep 16, 2025, 10:54:02 AM 2 min read # U.S. Court of Appeals for the D.C. Circuit Decides SSI Case [Previous](https://public.govdataservices.com/the-scoop/cms-ffy-2026-skilled-nursing-final-rule) [Next](https://public.govdataservices.com/the-scoop/district-court-for-district-of-columbia-rules-retroactive-2023-part-c-rule-is-impermissible) **Battle Creek Health System, et al. v. Robert F. Kennedy** **Court:** U.S. Court of Appeals for the District of Columbia **Decision Date:** August 22, 2025   **Overview** The Court of Appeals **reversed** a prior District Court decision that had allowed providers to appeal their SSI ratios before the issuance of a Notice of Program Reimbursement (NPR) on finalized cost reports.   The Appeals Court held that hospitals must **wait until the NPR is issued**—and the corresponding final DSH adjustment is made—before challenging an SSI ratio.   **Procedural History** - **2009:** Hospitals (including Battle Creek Health System) appealed to the PRRB. - **2017:** The PRRB dismissed for **lack of jurisdiction**, stating it could only hear appeals on finalized reimbursement determinations (i.e., post-NPR). - **District Court (2023):** Found that providers could appeal published SSI ratios before NPR, granting broader provider rights to contest ratios early. - **Court of Appeals (2025):** Reversed, holding that no final determination had been made at the time of the original appeal. **Key Judicial Reasoning** The Appeals Court distinguished between: - **The SSI ratio itself being published (and thus “fixed”),** versus - **The Medicare DSH impact not being final until the NPR.** Quoting the opinion: “At that time, in short, there had not been a ‘final determination of the Secretary as to the amount of the payment’ under the PPS. 42 U.S.C. § 1395oo(a)(1)(A)(ii). The Board thus lacked jurisdiction over the hospitals’ appeal, as it correctly determined.” **Implications for Providers** - Hospitals must **wait for final DSH adjustments under the NPR** before pursuing SSI ratio appeals. - This ruling **narrows providers’ ability to preemptively challenge ratios** and delays litigation timelines. ![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 Sep 25, 2026, 10:26:12 AM 1 min read 1115 Waiver Day Battle Headed Back to Fifth Circuit Court On September 24, HHS filed its notice of appeal to the Fifth Circuit following the Northern District of Texas's July ruling in ... 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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/us-court-of-appeals-for-the-dc-circuit-decides-ssi-case" } ``` ```json { "@context" : "http://schema.org", "@type" : "BlogPosting", "abstract" : "The Court of Appeals reversed a prior District Court decision that had allowed providers to appeal their SSI ratios before the issuance of a Notice of Program Reimbursement (NPR) on finalized cost reports.", "author" : { "@type" : "Person", "name" : "Chris Cusimano" }, "dateModified" : "September 16, 2025 2 PM", "datePublished" : "September 16, 2025 2 PM", "headline" : "U.S. Court of Appeals for the D.C. Circuit Decides SSI Case", "image" : "https://21378692.fs1.hubspotusercontent-na1.net/hubfs/21378692/Doctor%20working%20with%20digital%20tablet%20and%20laptop%20computer%20in%20medical%20workspace%20office%20and%20overcast%20exposure%20effect.jpeg", "inLanguage" : "en", "keywords" : "[Legal News]", "mainEntityOfPage" : { "@type" : "WebPage" }, "name" : "U.S. Court of Appeals for the D.C. Circuit Decides SSI Case", "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "" }, "name" : "" }, "text" : "Battle Creek Health System, et al. v. Robert F. Kennedy Court: U.S. Court of Appeals for the District of Columbia Decision Date: August 22, 2025 Overview The Court of Appeals reversed a prior District Court decision that had allowed providers to appeal their SSI ratios before the issuance of a Notice of Program Reimbursement (NPR) on finalized cost reports. The Appeals Court held that hospitals must wait until the NPR is issued—and the corresponding final DSH adjustment is made—before challenging an SSI ratio. Procedural History 2009: Hospitals (including Battle Creek Health System) appealed to the PRRB. 2017: The PRRB dismissed for lack of jurisdiction, stating it could only hear appeals on finalized reimbursement determinations (i.e., post-NPR). District Court (2023): Found that providers could appeal published SSI ratios before NPR, granting broader provider rights to contest ratios early. Court of Appeals (2025): Reversed, holding that no final determination had been made at the time of the original appeal. Key Judicial Reasoning The Appeals Court distinguished between: The SSI ratio itself being published (and thus “fixed”), versus The Medicare DSH impact not being final until the NPR. Quoting the opinion: “At that time, in short, there had not been a ‘final determination of the Secretary as to the amount of the payment’ under the PPS. 42 U.S.C. § 1395oo(a)(1)(A)(ii). The Board thus lacked jurisdiction over the hospitals’ appeal, as it correctly determined.” Implications for Providers Hospitals must wait for final DSH adjustments under the NPR before pursuing SSI ratio appeals. This ruling narrows providers’ ability to preemptively challenge ratios and delays litigation timelines.", "url" : "https://public.govdataservices.com/the-scoop/us-court-of-appeals-for-the-dc-circuit-decides-ssi-case", "wordCount" : "414" } ``` ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Chris Cusimano", "url" : "https://public.govdataservices.com/the-scoop/author/chris-cusimano" }, "dateModified" : "2025-09-16T14:54:02.941Z", "datePublished" : "2025-09-16T14:54:02.000Z", "headline" : "U.S. Court of Appeals for the D.C. Circuit Decides SSI Case", "image" : [ "https://public.govdataservices.com/hubfs/Doctor%20working%20with%20digital%20tablet%20and%20laptop%20computer%20in%20medical%20workspace%20office%20and%20overcast%20exposure%20effect.jpeg" ], "mainEntityOfPage" : { "@id" : "https://public.govdataservices.com/the-scoop/us-court-of-appeals-for-the-dc-circuit-decides-ssi-case", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject" } } } ```