PRRB Dec. No. 2007-D13

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Decision Number
PRRB Dec. No. 2007-D13
Case Name
Rush Presbyterian- St. Lukes Medical Center (n/k/a Rush University Med. Ctr.) vs. BlueCross BlueShield Association/AdminaStar Federal-Illinois
Issue
1. Whether the Provider's transplant surgery residents should be included in the full-time equivalent (FTE) count for the purposes of both direct graduate medical education (GME) and indirect medical education (IME) reimbursement. 2. Whether the Provider was entitled to reimbursement under 42 CFR 405.523 for the costs it incurred for its transplant surgery fellowship residents. 3. Whether the Intermediary, in calculating the Provider's Disproportionate Share Hospital (DSH) payment, should have included all of the
Medicaid Health Maintenance Organization (HMO) days, as reported by the Illinois Department of Public Aid (IDPA). 4. Whether the Intermediary's disallowance of a portion of the depreciation expense claimed for the Provider's Atrium Pavilion was proper.

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