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
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.
