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Appeals Of The Exclusion from the DPP of Labor/Delivery Room Inpatient Days

 

 

  • Before December 1991, an inpatient day for a Labor/Delivery Room (LDR) patient, admitted at the census-taking hour was counted for purposes of both the DSH payment adjustment and for allocating costs on a provider's cost report. [See 74 Fed. Reg. 43754, 43899 (Aug. 27, 2009) FY 2010 IPPS Final Rule].
     

  • In response to judicial precedent, CMS later revised both its DSH policy and its cost allocation policy by counting LDR inpatient days only if the patient occupied a routine care bed prior to occupying an ancillary LDR bed before the census-taking hour. [Id. at 43899-900, see also 68 Fed. Reg. 45346, 45419-20, 45490 (Aug. 1, 2003)(Final Rule) Amending 42 C.F.R. § 412.106 (a)(1)(ii)(B)].
     

  • In the FY 2010 Final Rule, CMS again revised its DSH policy by including LDR inpatient days in the DPP if the LDR patient was admitted as a hospital inpatient, regardless of whether the LDR patient had occupied a routine care bed prior to occupying an ancillary LDR bed before the census-taking hour. [74 Fed. Reg. at 43900-01, 43997 (amending 42 C.F.R. § 412.106 (a)(1)(ii)(B)].
     

  • Per CMS, LDR inpatient days belong in the DPP if such days meet the requirements for inclusion in the Medicaid fraction or the SSI fraction, regardless of whether the LDR patient had occupied a routine care bed prior to occupying an ancillary LDR bed before the census-taking hour.
     

  • CMS and Medicare contractors will ensure that a hospital's LDR inpatient days are included in the Medicaid fraction (or SSI fraction), in calculating the DSH payment for each open cost report for a pre-October 1, 2009 cost reporting period where the contractor has not yet settled finally the provider's Medicare cost report through the issuance of an initial NPR (42 C.F.R. § 405.1801(a) and 405.1803).
     

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