Payment Matters: CMS Proposed Rule May Offer Relief to Medicaid DSH Providers


CMS issued a proposed rule [PDF] last week that would change the way the hospital-specific limitation for the Medicaid disproportionate share hospital (DSH) adjustment is calculated. The proposed rule would effectively increase the amount of uncompensated care included in the hospital-specific limit, which caps the Medicaid DSH adjustment at the total uncompensated costs of providing inpatient and outpatient hospital services to Medicaid eligible individuals and uninsured individuals.

The proposed rule would reverse a 2008 change to the definition of “uninsured,” which had restricted the types of uncompensated care included in the hospitalspecific limit. Prior to the 2008 change, individuals were considered uninsured if they did not have insurance for the specific services provided by the hospital. In 2008, CMS changed the definition of “uninsured” to exclude individuals with any form of insurance coverage, even when the services provided by the hospital were not actually covered. The 2008 rule effectively reduced the hospital specific limit by excluding the costs of many services provided to individuals with limited insurance coverage...

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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