Alert

The Centers for Medicare & Medicaid Services (CMS) published the Supplemental Security Income (SSI) percentages for fiscal year (FY) 2023.

Important information about the publication of percentages follows. The guidance takes effect April 14, 2025.

Key Information

Applicable Health Care Entities

CMS published SSI data for the following health care entities:

• Inpatient Prospective Payment System (IPPS) hospitals
• Inpatient rehabilitation facilities (IRFs)
• Long-term care hospitals (LTCHs) that bill Medicare Administrative Contractors (MACs) for Medicare beneficiaries’ services

Resources

The FY 2023 SSI percentages can be accessed electronically on the CMS website, and the following pages focus on each applicable health care entity:

• Ratios specific to IPPS hospitals
• Ratios specific to IRFs
• Ratios specific to LTCHs

Timing

On March 13, 2025, CMS issued Change Request 13971 (CR), providing technical direction to MACs.

The CR states that Medicare Part A “contractors shall update their IPPS, IRF, and LTCH provider specific files prospectively, within 30 days of the implementation date of this CR, using the latest year’s SSI Ratio posted to the CMS website as of the implementation date of this CR, except when explicitly directed otherwise by CMS.”

Data

The SSI data files contain:

• Provider number
• Provider name
• Total SSI days
• Total days
• Total SSI ratio—the ratio of days for patients entitled to Medicare Part A attributable to SSI recipients

Methodology for Calculating FY 2023 SSI Ratios

Subsequent to the decision in Empire Health Foundation v. Azar, the methodology for calculating FY 2023 SSI ratios uses total Medicare days, consistent with CMS’ prior regulation.

Considerations for Hospitals

Hospitals should keep the following factors in mind based on their classification.

IPPS Hospitals

FY 2023 SSI ratios will generally apply to Medicare cost reports beginning on or after October 1, 2022, and prior to October 1, 2023, for settlement purposes.

For IPPS hospitals, this updated data will be used to determine their Medicare Disproportionate Share (DSH) adjustment.

IRFs

IRFs will incorporate the updated percentages into their low-income patient (LIP) adjustment.

LTCHs

LTCH discharges paid under the short-stay outlier payment adjustment will use updated SSI data.

340B Impacts

The Medicare SSI percentage is integral in determining a hospital’s DSH adjustment percentage and plays a critical role in enrollment in and qualification for other reimbursement programs, such as the 340B drug discount program. Due to the effects of the Medicaid redeterminations and 2023 changes for inclusion of 1115 waiver days, many hospitals may find their 340B eligibility in jeopardy.

340B hospitals should determine if the 2023 SSI ratios will affect their DSH adjustment percentage causing them to fall below the 340B qualification threshold and disqualifying them for 340B participation. In this case, providers can employ a variety of strategies in response, including service line planning and bolstering revenue cycle functions.

Benefit of an SSI Percentage Recalculation for IPPS Hospitals

Current CMS regulations allow a hospital to request a recalculation of its Medicare fraction or SSI ratio based on the hospital’s cost-reporting period if it’s different from the federal fiscal year—October 1 through September 30.

Hospitals should research annually whether their facility could benefit from an SSI percentage recalculation, also known as an SSI realignment or redetermination. 

If this hasn’t been historically or consistently reviewed, it’s recommended that hospitals perform a look back through all years of their SSI data. SSI recalculations can provide additional opportunities to help increase DSH reimbursement.

Properly analyzing SSI data can be a complex process. If appropriate patient level SSI data isn’t fully obtained and analyzed properly, a recalculation could decrease your Medicare DSH reimbursement.

Learn more about how to determine the benefit of an SSI percentage recalculation and what data and analysis is required, or request a complimentary analysis to determine if your organization could benefit.

We’re Here to Help

To learn more about potential implications of the FY 2023 SSI ratios for your hospital or if you need help evaluating recalculation potential, contact your Moss Adams professional.

Additional Resources

• Provider Reimbursement Enterprise Services
• Supplemental Security Income Ratio Recalculations
• Medicare and Medicaid Cost Reimbursement Services