Provider petitions Supreme Court for Medicare reimbursement

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Providence Health System in Yakima, WA has petitioned the Supreme Court to take its case, regarding "new provider" status under Medicare law for skilled nursing facilities.

Providence opened a nursing home in May 1993, and contends that it qualified as a new provider at the time. Medicare imposes reasonable cost limitations on reimbursement for non-capital per diem costs, but skilled nursing facilities that qualify as new providers can be exempted from these for up to three years.

Providence obtained the rights for 12 beds from nearby Summitview Manor. The company did not previously provide skilled nursing.

CMS determined that the transfer of bed rights from Summitview to Providence qualified it as a change in ownership and not new provider status. The district court ruled Providence did indeed qualify as a new provider and therefore deserved its higher rate of payment for three years.
In December, the U.S. Court of Appeals for the Ninth Circuit reversed the district court's ruling and sided with CMS.
The petition was filed May 28 by Michael Madden with Bennett Bigelow & Leedom PS, Seattle.