News & Analysis as of

DSH

CMS Issues IPPS and LTCH PPS Final Rule for FY 2018

by King & Spalding on

On August 2, 2017, CMS issued the Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule (Final Rule) that updates...more

Manatt on Health: August 2017

Next Steps on Healthcare Reform - Though President Trump has continued to call for action on repeal and replace in the wake of the Senate’s failed vote at the end of July, congressional Republicans have been fairly muted...more

Healthcare Legislation Outlook and Update

by Holland & Knight LLP on

Below is a summary of recent U.S. Senate action on healthcare legislation and our outlook regarding coming issues and possible actions. Holland & Knight's Healthcare & Life Sciences Team will follow up as developments...more

CMS Proposes Methodology to Implement Statutory Medicaid DSH Reductions

by Reed Smith on

CMS has issued a proposed rule establishing a methodology to reduce state Medicaid disproportionate share hospital (DSH) allotments annually beginning with fiscal year (FY) 2018, as mandated by the Affordable Care Act (and...more

Health Care Weekly Preview from ML Strategies – July 2017 #2

Welcome back everybody. The absence of Senator John McCain (AZ) – who is recovering at home from a craniotomy – has caused Senate Republicans to delay consideration of the Better Care Reconciliation Act (BCRA) previously...more

Appeals Court Upholds Charity Care Patient Population Exclusion from DSH Payments

by King & Spalding on

On May 9, 2017, the U.S. Court of Appeals for the District of Columbia Circuit affirmed a lower court ruling denying hospitals from including New Jersey Charity Care Program (NJCCP) patients in the hospitals’ disproportionate...more

Health Update - May 2017

Mapping the Healthcare M&A Landscape Under the New Administration - Editor’s Note: The healthcare M&A market continues to be among the most active sectors. In a recent webinar, Manatt examined how the policies and goals of...more

CMS Releases FY 2018 Hospital Inpatient Prospective Payment System Proposed Rule and Request for Information

by King & Spalding on

On April 14, 2017, CMS issued the annual Hospital Inpatient Prospective Payment System (IPPS) Rule for FY 2018 (the “Proposed Rule”) which will affect discharges on or after October 1, 2017. CMS estimates that IPPS operating...more

What Could Reconciliation Mean for Medicaid: Reviewing HR 3762

President-elect Trump and leaders in Congress have proposed a major restructuring of the Medicaid program, but very significant changes to Medicaid coverage and financing could be adopted even before that debate begins as...more

First Circuit Upholds Exclusion of Dual-Eligible Patients That Are Not Entitled to SSI Benefits from Both the DSH Medicaid...

by King & Spalding on

The U.S. Court of Appeals for the First Circuit recently ruled in favor of HHS, overturning a $17 million district court decision, in a dispute dating back as far as the 1993 fiscal year over whether hospitals may include,...more

Medicaid DSH Allotments Announced

by Reed Smith on

CMS recently finalized the federal share disproportionate share hospital (DSH) allotments for federal fiscal year (FY) 2014 and announced preliminary federal share DSH allotments for FY 2016. ...more

CMS Announces DSH Allotments

by Reed Smith on

CMS has published the final fiscal year (FY) 2013 and preliminary FY 2015 disproportionate share hospital (DSH) allotments, along with final FY 2013 and preliminary FY 2015 limitations on aggregate DSH payments that states...more

Health Care Update - August 2015

CMS Releases Final Payment Rules (IPPS, IRF, LTCHs, Hospice, and Psych): At the end of last week, the Centers for Medicare and Medicaid Services (CMS) released a set of final 2016 payment rules affecting acute care hospitals...more

CMS Issues FY 2016 IPPS and LTCH Final Rule

by King & Spalding on

On July 31, 2015, CMS issued its final rule to update the fiscal year (FY) 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective...more

Challenge to DSH Adjustment Estimates Barred by Statute

by Baker Ober Health Law on

In a decision issued on March 31, the United States District Court for the District of Columbia dismissed a challenge by Florida Health Sciences Center, Inc., also known as Tampa General Hospital, to the calculation of its...more

New CMS Ruling on DSH Appeals for FY 2004 and Earlier

by Faegre Baker Daniels on

It’s a measure of the backlog in DSH (for Disproportionate Share Hospital) payment appeals that CMS is still issuing rulings for appeals applicable to treatment of patients before October 1, 2004. On April 24 CMS issued...more

Children’s Hospitals Obtain Temporary Injunction Against CMS

by BakerHostetler on

Challenging actions by the Centers for Medicare & Medicaid Services (CMS) under the Administrative Procedures Act (APA), Texas Children’s Hospital and Seattle Children’s Hospital obtained a preliminary injunction that enjoins...more

CMS Defines “Uninsured” for Medicaid DSH Payments But Leaves Impact on Hospital-Specific Payments Undefined

CMS’ Final Rule, “Medicaid; Disproportionate Share Hospital Payments – Uninsured Definition”, published on December 3, 2014, may offer relief to some hospitals receiving Medicaid disproportionate share hospital (DSH) payments...more

CMS Clarifies Definition of Uninsured Under the Hospital-Specific Limitation on Medicaid DSH Payments

by King & Spalding on

On Friday, November 28, 2014, CMS issued a Final Rule providing that, for purposes of the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments, the definition of “uninsured” will now be...more

Provider Reimbursement Review Board Issues 60 Day Deadline to Supplement Record in All DSH Medicaid Eligible Days Appeals

by King & Spalding on

On May 23, 2014, the CMS Office of Hearings released Alert 10, notifying providers of an important new 60 day deadline concerning certain appeals before the Provider Reimbursement Review Board (PRRB or Board). By the end of...more

PRRB Issues Alert Requiring Supplementation of Record in DSH Cases

by Baker Ober Health Law on

Recently, on May 23, the Provider Reimbursement Review Board (PRRB) issued its latest alert, Alert 10 (Alert), in an email blast. As of the writing of this article, the Alert had not been posted on the PRRB’s website....more

CMS Releases Proposed IPPS and LTCH Rule

by King & Spalding on

On April 30, 2014, CMS released the much anticipated proposed Hospital Inpatient Prospective Payment System rule (“Proposed IPPS Rule”), which would apply to FY 2015 Medicare payments. For inpatient acute care hospitals, CMS...more

Providers Win Significant Victory in DSH Part C Days Appeal

by Baker Donelson on

As we discussed in a Payment Matters article dated December 13, 2012, providers have enjoyed repeated success in challenging the Secretary’s position regarding Medicare Part C days and where those days belong in the Medicare...more

Providers Lose DSH GA Day Challenge

by Baker Donelson on

As we reported in a Payment Matters article dated April 18, 2013, in Nazareth Hosp. et al. v. Sebelius (“Nazareth”), the United States District Court for the Eastern District of Pennsylvania overturned CMS’s rejection of...more

D.C. Circuit Requires Greater Disclosure of Changes in Medicare Regulations

by Epstein Becker & Green on

The rulemaking process often accommodates a variety of interests, including the preference of regulatory agencies to maintain some flexibility and the rights of interested parties to participate in the regulatory process. On...more

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