2015D03

This case was remanded to the Board and the parties presented the following issues pursuant to the decision of the U.S. Court of Appeals for the Ninth Circuit ("Ninth Circuit") in Providence Yakima Medical Center v. Sebelius ("Providence Yakima"). The case involves the amount of Medicare reimbursement due a provider of medical services.
Issue 1: Was the use of CMS' sequential geography methodology ("SGM") for setting the Providers' base year per resident amounts for Medicare reimbursement of certain graduate medical education costs valid and consistent with 42 U.S.C. Section 1395ww(h)(2)(F) and 42 C.F.R. Section 413.86(e)(4)(i) (1989)?
Issue 2: If the SGM is invalid, what relief can or should the Board order?