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Ruling Index


CMS Ruling No: 1498-R
Date: April 28, 2010


1  Jurisdiction over appeals of Disproportionate Share Hospital (DSH) payments, and recalculations of
DSH payments following remands from administrative tribunals.


2  Citations.


3  Backgrounds.


4  DSH appeal issues and revised data matching process:

  • Appeals of the data matching process used in calculating the SSI fraction.

  • Appeals of exclusion from the DPP of non-covered inpatient hospital days for patients entitled to Medicare Part A, and days for which the patient's Part A inpatient hospital benefits were exhausted.

  • Appeals of the exclusion from the DPP of Labor/Delivery Room inpatient days.


    5  Implementation of this ruling:

  • The Standard Implementation Procedure.

  • The Alternative Implementation Procedure.

  • "Mixed" appeals where some claims are, but other claims are not, subject to the ruling.

  • Requests for review of a finding that a claim is not subject to the ruling.


    6  Implementation by CMS and the Medicare contractors:

  • Appeals on the SSI data matching process issue.

  • Appeals on non-covered inpatient day or exhausted benefit day issues.

  • Appeals on the Labor/Delivery Room inpatient day issue.

  • Cost reports not settled finally by an initial NPR.

  • Provision for unitary relief on all three DSH issues.