News & Analysis as of

Department of Health and Human Services (HHS) DSH

King & Spalding

D.C. Circuit Holds that Those “Entitled to Supplemental Security Income Benefits” Means Receiving Cash Payment for Hospital DSH...

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Last week, the D.C. Circuit held that Medicare beneficiaries “entitled to supplemental security income [(SSI)] benefits under Title XVI of the Social Security Act” means only those patients receiving cash payments for...more

King & Spalding

D.C. Circuit Affirms Order Directing CMS to Produce Evidence in Case Alleging SSI Data Matching Errors

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On September 1, 2023, the D.C. Circuit affirmed the D.C. District Court’s decision in Pomona Valley Hosp. Med. Ctr. v. Azar, 2020 WL 5816486, at *1 (D.D.C. Sept. 30, 2020) requiring CMS to produce affirmative evidence as to...more

King & Spalding

CMS Issues IPPS and LTCH PPS Final Rule for FY 2024

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On August 1, 2023, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule for FY 2024 (the Final Rule). In the Final Rule, CMS,...more

Holland & Knight LLP

Supreme Court Backs Rule That Decreases Medicare Payments to Safety-Net Hospitals

Holland & Knight LLP on

The U.S. Supreme Court settled an Administrative Procedures Act (APA) dispute on June 24, 2022, involving Medicare's formula to adjust rates paid to safety-net hospitals, clarifying a statute that dictates how to calculate...more

Lathrop GPM

U.S. Supreme Court Hears Oral Arguments in Two Hospital Cases This Week

Lathrop GPM on

This is a big legal week for hospitals and health systems as the U.S. Supreme Court heard not one, but TWO different oral arguments related to federal government payments to hospitals and health systems. In both cases, the...more

K&L Gates LLP

K&L Gates Triage: 340B Update - Hospitals Request Eligibility Flexibilities Amid COVID-19 Pandemic

K&L Gates LLP on

In this episode, Richard Church and Victoria Hamscho discuss recent developments in the 340B Drug Pricing Program, including recent COVID-19 guidance by the Health Resources and Services Administration and hospital requests...more

Manatt, Phelps & Phillips, LLP

Congress and Administration Consider Significant Drug Pricing Policy Changes

In both chambers of Congress, passing legislation to bring down drug prices is a policy priority—and the savings from such possible legislation is slated to offset other healthcare legislative proposals (such as addressing...more

Baker Donelson

Court Rules HHS 340B Payment Cuts Unlawful; HHS Seeks Stay in Proceedings

Baker Donelson on

In an opinion issued December 27, 2018, a Federal District Court ruled that the Department of Health & Human Services (HHS) exceeded its authority by reducing Part B drug reimbursement to certain hospitals in the 340B drug...more

King & Spalding

Supreme Court Will Review Allina II DSH Part C Decision to Resolve Circuit Split on Medicare Rulemaking Requirements

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On September 27, 2018, the U.S. Supreme Court granted certiorari to review the D.C. Circuit’s decision in favor of hospitals in Allina Health Services, et al. v. Price, 863 F.3d 937 (D.C. Cir. 2017) (Allina II).The Court’s...more

McDermott Will & Emery

Pushing “PAUSE” on the 340B Program: The New Bi-Partisan Bill that Could Reshape the 340B Program

In late December 2017, Republican Rep. Larry Bucshon (with bi-partisan support) introduced the “340B Protecting Access for the Underserved and Safety-net Entities Act” (340B PAUSE Act), legislation that would implement a...more

King & Spalding

Appeals Court Upholds Charity Care Patient Population Exclusion from DSH Payments

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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

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

Epstein Becker & Green

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

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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

BakerHostetler

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

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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

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