Sebelius v. Auburn Regional Medical Center, No. 11-1231; U.S. Supreme Court; opinion by Ginsburg, J.; concurrence by Sotomayor, J.; decided January 22, 2013. On certiorari to the U.S. Court of Appeals for the District of Columbia Circuit.
The reimbursement amount health-care providers receive for inpatient services rendered to Medicare beneficiaries is adjusted upward for hospitals that serve a disproportionate share of low-income patients. The adjustment amount is determined in part by the percentage of a hospital’s patients who are eligible for Supplemental Security Income (SSI), called the SSI fraction. Each year, the Centers for Medicare and Medicaid Services (CMS) calculates the SSI fraction for an eligible hospital and submits that number to the hospital’s “fiscal intermediary,” a Department of Health and Human Services (HHS) contractor. The intermediary computes the reimbursement amount due and then sends the hospital a Notice of Program Reimbursement (NPR). A provider dissatisfied with the determination has a right to appeal to the Provider Reimbursement Review Board (PRRB) within 180 days of receiving the NPR. See 42 U.S.C. § 1395oo(a)(3). By regulation, the secretary of HHS authorized the PRRB to extend the 180-day limit, for good cause, up to three years. See 42 CFR 405.1841(b) (2007).
