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Revised Policy (CMS)




Types of patient days under the CMS appeal ruling:

  • Included in SSI days (numerator):

  • Inpatient days of a person who was entitled to Medicare Part A are included in the numerator of hospital's DSH SSI fraction (provided that the patient was also entitled to SSI) and in the SSI fraction denominator, regardless of whether the individual's inpatient hospital stay was covered under (paid) Part A or whether the patient's Part A hospital benefits were exhausted.

  • Inpatient days for Medicare Part C (formally Medicare HMO days).

  • Per CMS, non-covered inpatient days (for example, MSP days) and the exhausted benefit days of patients who were still entitled to Part A do not belong in the numerator of the Medicaid fraction because, under section 1886(d)(5)(vi)(II) of the Act, the Medicaid fraction numerator consists of the number of Medicaid-eligible inpatient days of persons ‟who were not entitled to benefits under Part A‟.

  • CMS and MAC will resolve each properly pending DSH appeal, for cost reports with patient discharges before October 1, 2004, in which the hospital seeks inclusion in the DPP of inpatient days where the patient was entitled to Part A benefits but the inpatient hospital stay was not covered under Part A or the patient"s Part A hospital benefits were exhausted.

  • CMS and MAC will take the steps necessary to include the non-covered inpatient hospital days (for example, MSP days) and exhausted benefit inpatient days of patients entitled to Part A in the SSI fraction numerator and in the denominator of that fraction, and to recalculate the DSH payment adjustment, for each properly pending claim for a cost report with pre-October 1, 2004 discharges that is remanded by an administrative appeals tribunal.