Medicare DSH

Supreme Court Rejects Medicare DSH Challenge

The Supreme Court has rejected the appeal of a lower court ruling that found that the Centers for Medicare & Medicaid Services did not undercalculate hospitals’ Medicare disproportionate share payments between 2006 and 2009. In the suit, more than 200 hospitals argued that the calculation of Medicare DSH payments should be based on all hospitalized patients who qualify for both Supplemental Security Income (SSI) and Medicare. The Supreme Court disagreed, confirming in a 7-2 decision the ruling of lower courts that SSI should only be included in DSH calculations when Medicare patients receive SSI payments during the same month they [...]

joe2025-05-01T16:43:24-04:00May 5, 2025|Medicare disproportionate share, Medicare DSH|

Federal Health Policy Update for May 1

The following is the latest health policy news from the federal government for April 25 – May 1. Some of the language used below is taken directly from government documents. Congress Reconciliation The House and Senate returned to Washington D.C. this week and House committees have begun marking up reconciliation legislation for submission to the House Budget Committee by May 9. The Energy and Commerce Committee is expected to seek nearly $550 billion in cuts to Medicaid spending and the most likely targets for cuts continue to be work requirements for Medicaid eligibility; more frequent review of Medicaid eligibility; reducing the federal [...]

joe2025-05-01T15:33:24-04:00May 1, 2025|Centers for Medicare & Medicaid Services, Congress, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for January 16

The following is the latest health policy news from the federal government for January 11-17. Some of the language used below is taken directly from government documents. Congress House Budget Committee Republican members of the House Budget Committee have circulated a list of possible policy changes that would reduce federal spending by between $5.3 trillion and $5.7 trillion over a period of ten years. Up to $3.4 trillion of those possible cuts could include reductions in federal health care spending. The health care cuts the document lists (all figures are ten-year reductions) are: Medicare introducing Medicare site-neutral outpatient payments - [...]

House Committee Mulls Possible Health Care Cuts

Republican members of the House Budget Committee have circulated a list of possible policy changes that would reduce federal spending between $5.3 trillion and $5.7 trillion over a period of ten years. Up to $3.4 trillion of those possible cuts could include reductions in federal health care spending. The health care cuts the document lists (all figures are ten-year reductions) are: Medicare introducing Medicare site-neutral outpatient payments - $146 billion reducing Medicare disproportionate share (Medicare DSH) uncompensated care payments - $229 billion reducing Medicare bad debt reimbursement - $42 billion extending the Bipartisan Budget Act of 2013 budget sequestration that [...]

joe2025-01-14T15:44:54-05:00January 15, 2025|Affordable Care Act, Congress, deficit reduction, Federal Update, hospitals, Medicaid, Medicare, Medicare bad debt reimbursement, Medicare cuts, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy, Pennsylvania Update|

MedPAC Meets, Offers Preliminary 2026 Rate Proposals

MedPAC’s commissioners held their latest public meeting on Thursday, December 12 and Friday, December 13. The subjects on the meeting’s agenda were: assessing payment adequacy and updating payments: physician and other health professional services assessing payment adequacy and updating payments: hospital inpatient and outpatient services; and mandated report on rural emergency hospitals assessing payment adequacy and updating payments: skilled nursing facility services assessing payment adequacy and updating payments: inpatient rehabilitation facility services assessing payment adequacy and updating payments: home health care services assessing payment adequacy and updating payments: hospice services assessing payment adequacy and updating payments: outpatient dialysis services In [...]

joe2024-12-17T13:33:44-05:00December 17, 2024|Centers for Medicare & Medicaid Services, hospitals, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for August 22

The following is the latest health policy news from the federal government for August 16-22. Some of the language used below is taken directly from government documents. The Courts The federal government must include uninsured patients whom hospitals serve under state Medicaid waivers when calculating hospitals’ Medicare DSH payments, a federal court has ruled. In the case of Baylor All Saints Medical Center, et al. v. Xavier Becerra, federal policymakers had invoked a 2023 regulation that excluded counting care provided to patients served by DSH-eligible hospitals providing care through state Medicaid waivers – generally, through uncompensated care pools. A group [...]

joe2024-08-22T15:11:48-04:00August 22, 2024|Alternative payment models, Center for Medicare and Medicaid Innovation, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, Telehealth|

Federal Court Rejects Medicare DSH Regulation

The federal government must include uninsured patients that hospitals serve under state Medicaid waivers when calculating hospitals’ Medicare DSH payments, a federal court has ruled. In the case of Baylor All Saints Medical Center, et al. v. Xavier Becerra, federal policymakers had invoked a 2023 regulation that excluded counting care provided to patients serve by DSH-eligible hospitals providing care through state Medicaid waivers – generally, through uncompensated care pools. A group of DSH-eligible hospitals in Texas sued over the regulation because its implementation reduced their Medicare DSH funding – money intended to help hospitals that care for especially large numbers [...]

joe2024-08-20T16:50:08-04:00August 21, 2024|Medicare disproportionate share, Medicare DSH, Medicare regulations|

Federal Health Policy Update for August 5

The following is the latest health policy news from the federal government for July 19 – August 5. Some of the language used below is taken directly from government documents. CMS – Medicare Payment Regulations Final FY 2025 Inpatient Prospective Payment System Regulation CMS has finalized its hospital inpatient prospective payment system rule for FY 2025. In the next fiscal year CMS will increase Medicare inpatient payments 2.9% while cutting Medicare disproportionate share hospital payments (Medicare DSH) $200 million. It also has: finalized its use of new core-based statistical area (CBSA) delineations for use in Medicare wage index calculations; established [...]

joe2024-08-06T14:25:10-04:00August 6, 2024|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, health equity, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

Federal Health Policy Update for June 13

The following is the latest health policy news from the federal government for June 7-13. Some of the language used below is taken directly from government document. Supreme Court The Supreme Court has agreed to hear a challenge to how the Department of Health and Human Services calculates hospitals’ Medicare disproportionate share (Medicare DSH) payments. The case was added to the court’s 2024-2025 schedule. Congress Individual members and key committees in Congress continue to introduce and mark up health care-related legislation with an eye toward including these initiatives in an end-of-year package. This work is expected to continue through the [...]

joe2024-06-13T20:15:06-04:00June 13, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

Supreme Court to Review Medicare DSH Case

The Supreme Court will hear a challenge to how the federal government calculates Medicare disproportionate share hospital payments (Medicare DSH) for hospitals that serve especially large numbers of low-income patients. At the heart of the issue is the Department of Health and Human Services’ contention that patients who are enrolled in Social Security’s Supplemental Security Income program but are not receiving supplemental payments at the time of their admission to a hospital should not count toward a hospital’s percentage of low-income patients in the calculation of Medicare DSH payments. A 2022 federal appeals court decision supported HHS’s approach. Learn more [...]

joe2024-06-12T15:01:06-04:00June 12, 2024|Medicare disproportionate share, Medicare DSH|