Under Section 1878 of the Social Security Act and the regulations at 42 CFR 405.1875, the Administrator of the Centers for Medicare & Medicaid Services has the authority to review decisions rendered by the Provider Reimbursement Review Board and to issue final Agency decisions for the Secretary of the Department of Health and Human Services. If you need a copy of a decision that is not listed on this site, please contact the Office of the Attorney Advisor. Please note that, because of 508 compliance needs, these decisions are not copies of the actual signed Administrator decisions. Copies of the actual signed decisions may be obtained from the Office of the Attorney Advisor.
|Decision Number||Case Name||Issue|
|HealthSouth 2006 SSI Percentage Group/HealthSouth 2007 SSI Percentage CIRP Group vs. Cahaba Government Benefits Administrators, LLC
||Whether the Board had jurisdiction to review the Medicare Contractor’s determination of the low-income patient (LIP) adjustments for the cost reporting periods at issue for the inpatient rehabilitative facilities.
|2003-D1||Skaggs Community Health Center vs. Mutual of Omaha Insurance Company||Whether the Intermediary's adjustments reclassifying home health agency (HHA) building rent to the HHA cost center and the elimination of corresponding square footage allocation statistics were proper.|
|2003-D10||Christ the King Manor vs. Blue Cross and Blue Shield Association/Veritus Medicare Svcs.||Whether the Intermediary's reclassification of the Staff Development Coordinator salaries was proper.|
|2003-D11||SNI Home Care, Inc. vs. Blue Cross and Blue Shield Association/Cahaba Government Benefit Administrators||Whether the Intermediary's application of the Salary Equivalency Guidelines (Guidelines) to the Provider's physical therapy costs was proper.|
|2003-D12||Susquehanna Regional Home Health Services vs. Blue Cross and Blue Shield Association/Cahaba Government Benefit Administrators||Whether the Intermediary's adjustment to rent paid by the Provider to a related party was proper.|
|2003-D14||Ingham Regional Medical Center vs. United Government Services, LLC-WI||Whether the Board has jurisdiction over the calculation of the disproportionate share adjustment where the issue is added to the appeal of an original Notice of Program Reimbursement.|
|2003-D15||Long Island State Veterans Home vs. Blue Cross and Blue Shield Association/Empire Medicare Services||Whether it was proper for the Intermediary to apply the lower of cost or charges (LCC) principle in calculating the Provider's reimbursement on the Medicare cost report Worksheet E, Part I|
|2003-D16||BBL 95-99 Observation Bed Days Group vs. Blue Cross Blue Shield Association/Premera Blue Cross/Riverbend Government Benefits Administrator/Trailblazer Health Enterprises||Whether the Intermediaries' determination that the Providers had less than 100 ?beds? for disproportionate share (DSH) eligibility purposes was proper.|
|2003-D17||Natividad Medical Center vs. Blue Cross Blue Shield Association/United Government Services||Whether the Intermediary's adjustment to the residents count and Graduate Medical Education payments was proper.|
|2003-D18||Spalding Rehabilitation Hospital vs. Mutual of Omaha Insurance Company||Whether the Intermediary incorrectly determined that the Provider was not entitled to a new provider exemption from the application of the skilled nursing facility for its provider-based skilled nursing facility.|