News & Analysis as of

Disproportionate Share Adjustments Appeals Medicaid

King & Spalding

Florida Hospitals Prevail in D.C. Circuit Appeal Regarding the Exclusion of Low-Income Pool Days from the Medicare...

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On November 13, 2020, the United States Court of Appeals for the District of Columbia Circuit affirmed a grant of summary judgment to the Florida Hospital Association and ten Florida hospitals represented by King & Spalding...more

Mitchell, Williams, Selig, Gates & Woodyard,...

State Hospital Association Fights Changes to Medicaid DSH Payment Rules

For hospitals that “serve a disproportionate number of indigent patients” Medicaid allows for supplemental payments to help ensure their financial viability. The calculation of those supplemental payments recently became the...more

King & Spalding

D.C. Circuit Court Reinstates 2017 Final Rule Limiting Hospitals’ Medicaid Disproportionate Share Hospital (DSH) Funding

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On August 13, 2019, the U.S. Court of Appeals for the District of Columbia Circuit overturned a district court ruling that CMS’s 2017 final rule on the Medicaid DSH program limit calculation violates the Medicaid Act, 42...more

Baker Donelson

New Medicaid DSH Audit Guidance: Its Impact on Pending and Recent State DSH Audits

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On December 31, 2018, the Center for Medicaid and CHIP Services issued a notice indicating that CMS was altering its prior audit guidance for Medicaid Disproportionate Share Hospital (DSH) audits that had previously been...more

Baker Donelson

A SLIP on the LIP Adjustment: No Judicial Review Available for Hospitals' LIP Challenges

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In Northeast Hosp. Corp. v Sebelius, 657 F.3d 1 (D.C. Cir. 2011), the United States Court of Appeals for the District of Columbia Circuit upheld hospitals' challenge to CMS's disproportionate share hospital (DSH) calculation...more

King & Spalding

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

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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

Baker Donelson

D.C. Circuit Precludes Review of DSH Uncompensated Care Data

Baker Donelson on

On July 26, 2016, the United States Court of Appeals for the District of Columbia Circuit decided Fla. Health Sciences Ctr. v. Burwell. In that case, the Court analyzed a statutory bar against judicial review of estimates...more

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