Instructions for Processing Requests for SSI Realignment for Cost Reporting Periods Starting Before October 1, 2013

Published 09/18/2024

With the issuance of the final rule (CMS-1739-F), the processing of realignment requests for cost reporting period starting before FY 2014 will resume. Cost reporting period-based SSI ratios for periods starting before October 1, 2013, are available on the Disproportionate Share Hospital (DSH) webpage of the CMS website.

This change request (CR 13413, PDF) requires hospitals to confirm or withdraw all previously submitted realignment requests that the provider submitted to its Medicare Administrative Contractor (MAC) prior to March 25, 2024. In addition, this change request allows hospitals to submit new realignment requests for cost reporting periods beginning prior to October 1, 2013. To confirm an existing request or make a new request for cost reporting periods starting before October 1, 2013, the provider must send a written notification to the MAC which contains the following information:

  • Cost report begin date
  • Cost report end date
  • Action Requested confirm, withdraw or new

Please submit the requests via email to the following email address:

Please do not send additional attachments such as original requests letters or copies of Notice of Reopening letters. The MAC requires a listing that includes the provider number (one provider number per email), fiscal year beginning and ending dates, and the action requested (confirm, withdraw or new). Each email may include multiple fiscal years but only for one provider number. If the email is submitted by the consultant, please include signed agent authorization. Please note that requests that do not follow the above noted requirements, we will notify the provider that the request will not be processed unless the provider resubmits the realignment with the proper information. If the MAC does not receive written notification confirming or withdrawing previously requested realignments, these requests will remain on hold and will not be worked.

Once a hospital has confirmed its request for realignment of cost reporting periods starting before October 1, 2013, (in the case of requests made prior to March 24, 2024, or new requests for such a reporting period), that request may not be withdrawn. The realigned ratio for the cost reporting period (posted on the CMS DSH website) will be the hospital’s ratio, regardless of whether the ratio is higher or lower than the federal fiscal year.


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