2015D16

Does the Provider Reimbursement Review Board (“Board”) have jurisdiction to review the Medicare Contractor’s determination of low-income patient (“LIP”) adjustment for Sutter Auburn Faith Hospital (“Auburn”) for fiscal year (“FY”) 2006? Specifically, Auburn filed an appeal with the Board claiming that:
1. the Medicare Contractor improperly excluded from the Medicaid fraction of Auburn’s LIP adjustment calculation the days of Rehab patients who were eligible for medical assistance under an approved Medicaid state plan; and
2. the LIP Supplemental Security Income (“SSI”) ratio published by Centers for Medicare and Medicaid Services (“CMS”) and used by the Medicare contractor in the calculation of Auburn’s LIP adjustment was understated.