News & Analysis as of

Healthcare DSH

Quarles & Brady LLP

Federal Spending Bill Offers Re-Enrollment Path for Some Hospitals

Quarles & Brady LLP on

In a move welcomed by the growing number of hospitals forced out of the 340B Program due to falling disproportionate share hospital (DSH) adjustment percentages, Congress has passed a measure offering a chance to rejoin....more

Mintz - ML Strategies

Health Care Update - August 2015

Mintz - ML Strategies on

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

Faegre Drinker Biddle & Reath LLP

New CMS Ruling on DSH Appeals for FY 2004 and Earlier

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

King & Spalding

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

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

King & Spalding

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

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

Baker Donelson

PRRB Issues Alert Requiring Supplementation of Record in DSH Cases

Baker Donelson 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

Baker Donelson

Providers Win Significant Victory in DSH Part C Days Appeal

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

Baker Donelson

Providers Lose DSH GA Day Challenge

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

Epstein Becker & Green

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

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

King & Spalding

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

King & Spalding on

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

BakerHostetler

CMS Issues Final Rule Outlining Medicaid DSH Payment Reductions

BakerHostetler on

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

Baker Donelson

Court of Appeals Hands Down Significant DSH Ruling

Baker Donelson on

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

King & Spalding

DC Circuit Issues Latest DSH Decision, Reducing Reimbursements

King & Spalding on

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

BakerHostetler

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

BakerHostetler on

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

Baker Donelson

CMS Provides More Information on New Medicare DSH Payment Calculations

Baker Donelson on

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

Cozen O'Connor

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

Cozen O'Connor on

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

Baker Donelson

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

Baker Donelson on

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

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