Disproportionate Share Hospital (DSH) Routine Use Data is now available through CMS. In our Update indicating new SSI Ratios for Medicare DSH were published on March 16, 2012 for Fiscal Years (FYs) 2006 – 2009, we recommended that Hospitals obtain their DSH Routine Use Data in order to have the underlying data used by CMS to calculate their SSI ratios. This DSH Data should separately identify Hospitals’ Medicare Advantage SSI Days used in the SSI ratio. CMS is holding a webinar on Tuesday, May 8, 2012 from 2:00 – 3:30 EST to discuss the Data Use Agreement (DUA) requirements and expiration policy. For more information on the webinar, click here.
The DSH DUA form is available on the CMS website. Providers should complete, print, sign and scan in the DUA and send it to DataUseAgreement@cms.hhs.gov. The signed and scanned document should be attached to the email as a .pdf, .jpg, .tif or bitmap image. CMS will no longer require a cover letter for these purposes. Notification of the DUA creation will be sent to the Requestor within 3-5 business days of receipt of the request. The data will be shipped to the Custodian in approximately 6-8 weeks.
Providers that submitted a request when CMS was not accepting requests because this data was not available must submit a new request. All other DSH related requests, such as changes to the Requestor/Custodian(s), updates to the files included in the DUA and DUA extension and closure requests, should also be attached to an email and submitted to the same DUA email address listed above.
CMS no longer requires Hospitals to have a properly pending appeal relating to DSH payments in order to process a Hospital’s request for the data used to compute the Medicare fraction of the Hospital’s DSH patient percentage. However, a DUA must be submitted, per the instructions above.
CMS has also developed a limited view of the HIPAA Eligibility Transaction System (HETS) to allow hospitals that receive Medicare DSH payments to view Medicare enrollment information. This will allow hospitals to verify that patients eligible for Medicaid are not also entitled to Medicare and therefore can be included in the Medicaid proxy. Hospitals can also determine whether a patient is entitled to Medicare Part A benefits, enrolled in a Medicare managed care plan or has Medicare as a secondary insurance. More information on this can be found here.
If you have any questions regarding this article, please contact:
- Maureen O’Brien Griffin at 317-977-1429 or mgriffin@hallrender.com;
- Lauren G. Hulls at 317-977-1467 or lhulls@hallrender.com; or
- Your regular Hall Render attorney.
