DSH

News & Analysis as of

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

Growth Of The 340b Program: Past Trends, Future Projections

The 340B program provides certain healthcare providers (referred to as “covered entities”) access to deeply discounted pharmaceuticals for outpatient use. Congress created the program in 1992 to help uninsured and vulnerable...more

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

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

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

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

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

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

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

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

Third Circuit Rules General Assistance Days May Be Excluded from DSH Payments

The Third Circuit recently issued an opinion in Nazareth Hospital et al. v. Sebelius, No. 13-2627, holding that Medicaid pilot projects, known as Section 1115 waiver projects, were different enough from the State of...more

Medicaid DSH: Little-Noticed CMS Rule Interpretation Creates Serious Financial Shortfalls for Impacted Hospitals

In what may have been a largely unnoticed rule interpretation affecting hospitals that treat a high percentage of children in the Medicaid program, CMS, in January 2010, issued a response to a Frequently Asked Question (FAQ)...more

CMS Announces New Cost Reporting Procedures to Address DSH Uncompensated Care Payments

In the fiscal year 2014 Inpatient Prospective Payment System (IPPS) rule (the “final rule”), CMS explained the new disproportionate share hospital (DSH) payment methodology that took effect this October 1. As we reported in...more

CMS Issues Final Rule Outlining Medicaid DSH Payment Reductions

CMS recently released the final rule confirming its methodology for carrying out reductions to Medicaid disproportionate share hospital (DSH) payments for fiscal year (FY) 2014 and FY 2015. DSH payments, which go to hospitals...more

Court of Appeals Hands Down Significant DSH Ruling

As we reported in a Payment Matters article dated February 16, 2012, early last year the United States District Court for the District of Columbia handed providers a significant victory in Catholic Health Initiatives-Iowa v....more

DC Circuit Issues Latest DSH Decision, Reducing Reimbursements

On June 11, 2013, the D.C. Circuit Court issued the latest ruling relating to the proper calculation of hospitals’ disproportionate share hospital (DSH) payment, leading to potentially lower Medicare reimbursements related to...more

The ACA DSH Allotment Reductions: The Balancing Act Between Full Coverage and the Uninsured Continues

As soon as the Supreme Court released its decision regarding the optional nature of the Affordable Care Act's (ACA) Medicaid expansion provision in June 2012, the hospital industry became concerned over the law's imposed...more

CMS Provides More Information on New Medicare DSH Payment Calculations

In the proposed federal fiscal year (FY) 2014 inpatient prospective payment system (IPPS) rule, CMS provided added details on the new Medicare disproportionate share hospital (DSH) calculation methodology. The provisions of...more

CMS Prevails in DSH Challenge Involving Waiver-Expansion Days

Over the years, CMS and its contractors have wrestled with how days approved under a Medicaid demonstration project should be counted, if at all, for purposes of the Medicare disproportionate share hospital (DSH) calculation....more

Hospitals Prevail in Effort to Include Pennsylvania GA Days in the Medicare DSH Calculation

Two of Mercy Health System’s hospitals (Nazareth Hospital and the former St. Agnes Medical Center) successfully challenged, before Judge Ludwig of the U.S. District Court for the Eastern District of Pennsylvania, the...more

Court Grants Unexpected Victory to Providers on Medicare DSH Adjustment

The United States District Court for the Eastern District of Pennsylvania’s opinion in Nazareth Hosp. v. Sebelius, slip op. no. 10-3513 furnished a surprising victory to two providers that challenged the calculation of the...more

President’s Budget Proposes to “Clarify” that the DSH Medicare Fraction Includes Exhausted and MA Days

The President’s proposed budget for FY 2014, released last week, includes a line item at page 197 that proposes to "Clarify the Medicare Fraction in the Medicare Disproportionate Share Hospital (DSH) statute." This line item...more

The New DSH - Are You Supplying The Correct Data That Will Drive Your Payments?

Effective October 1, 2013, CMS will begin paying disproportionate share hospitals differently. Congress ordered the change to the disproportionate share hospital (DSH) adjustment payment methodology as part of the Patient...more

Court of Appeals Rules for Government in DSH Exhausted Benefit Day Appeal

For the last several years, hospitals and the government have fought hard over where days associated with certain “dual eligible” patients should be placed in the Medicare disproportionate share hospital (DSH) calculation. At...more

Health Reform + Related Health Policy News Update - January 24, 2013

In This Issue: - OMB Directs Department Heads to Prepare for Sequestration - HHS Finalizes Omnibus HIPAA Rule, Enhances Privacy Requirements - SCOTUS Says Equitable Tolling Not a Factor in DSH Case - Report...more

Bolstered By Favorable District Court Decision, King & Spalding Now Forming Group Appeals Contesting Inclusion of Part C Days in...

In a recent decision for which King & Spalding organized the appealing group of hospitals and was co-counsel, the D.C. district court ruled that CMS’s regulation requiring the inclusion of Medicare Part C patient days in the...more

25 Results
|
View per page
Page: of 1