Disproportionate Share Hospital (DSH) Payments

On December 26, 2013, President Obama signed into law H.J. Res. 59, the Bipartisan Budget Act of 2013, which includes the Pathway for SGR Reform Act of 2013 (“the Act”). In addition to establishing federal budget targets for fiscal years (FYs) 2014 and 2015, the Act includes a number of provisions impacting the Medicare and Medicaid programs. Most notably, the Act provides a short-term reprieve from a looming Medicare physician fee schedule cut while lawmakers work to finalize a longer-term solution. It also extends Medicare provider payment cuts under existing sequestration authority for two years and makes a variety of other policy changes. The Act’s major Medicare and Medicaid provisions are summarized in our full post.
Continue Reading President Signs 2-Year Funding Bill with Medicare SGR Patch, Sequestration Extension for Medicare Providers

On October 3, 2013, CMS published an interim final rule with comment period revising disproportionate share hospital (DSH) payment calculations. By way of background, in the FY 2014 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment (PPS) final rule, CMS established a methodology for determining the amount of uncompensated care

CMS has put on display a final rule that implements reductions to state Medicaid Disproportionate Share Hospital (DSH) allotments mandated by the ACA. The final rule sets forth the methodology to implement the annual reductions for fiscal years (FYs) 2014 and 2015, and it establishes additional DSH reporting requirements for use in implementing the DSH

On August 19, 2013, the Centers for Medicare & Medicaid Services (CMS) published a final rule updating FY 2014 Medicare payment policies and rates under the acute inpatient prospective payment system (IPPS) and the long-term care hospital (LTCH) prospective payment system (PPS). The following are highlights of the lengthy rule:
Continue Reading CMS Finalizes FY 2014 Medicare IPPS, LTCH Rates

On May 10, 2013, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule updating Medicare inpatient prospective payment system (IPPS) and long-term acute care hospital prospective payment system (LTCH PPS) rates and policies for fiscal year (FY) 2014, which begins October 1, 2013. Comments on the proposed rule will be accepted until June 25, 2013. Highlights of the sweeping rule include the following: Continue Reading CMS Proposes Medicare IPPS and LTCH PPS Rates/Policies for FY 2014

Today, the Obama Administration released its proposed federal budget for fiscal year 2014. As widely reported, the budget incorporates an offer the President made to Congress in December 2012 to achieve nearly $1.8 trillion in additional deficit reduction over the next 10 years, including $401 billion in health savings (the Administration observes that this level of cuts would “provide more than enough deficit reduction to replace the damaging cuts required by the Joint Committee sequestration”).

Virtually all provider types – and drug manufacturers – would be impacted by the budget provisions, if adopted as proposed. The budget proposal is certainly subject to change during the legislative process, particularly as the House and Senate leadership pursue alternative budget frameworks, and indeed, gridlock could prevent significant action on entitlement reform this year. Nevertheless, the proposals bear careful monitoring because they could eventually be included in any long-elusive “grand bargain” to reform the Medicare program and reduce the federal debt.

Highlights of the Administration’s Medicare and Medicaid proposals include the following:Continue Reading Obama Administration’s Proposed FY 2014 Budget Includes $401 Billion in Health Program Savings

On January 2, 2013, President Obama signed into law (via autopen) the “fiscal cliff” deal, H.R. 8, the American Taxpayer Relief Act of 2012 (ATRA). In addition to making well-publicized changes to the tax code, the new law includes numerous Medicare payment provisions. Most notably, the law includes a one-year Medicare physician fee schedule (MPFS) fix that is paid for by approximately $30 billion in other health care (mainly Medicare) spending reductions over 10 years. ATRA also delays until March 2013 the automatic, across-the-board “sequestration” cuts in federal spending imposed by the Budget Control Act of 2011, which are expected to reduce Medicare provider payments by more than $11 billion in fiscal year (FY) 2013 and $123 billion over the period of FY 2013 to 2021. The delay in sequestration, coupled with the government again reaching its debt ceiling, sets up another near-term battle on federal spending, during which Medicare, Medicaid, and other health care programs could be targeted for even more significant cuts.

The health provisions of ATRA are summarized in our client alert.
Continue Reading Fiscal Cliff Deal Includes Medicare Cuts and Other Health Policy Changes

The Government Accountability Office (GAO) has issued a report entitled “States Reported Billions More in Supplemental Payments in Recent Years.” According to the GAO, states reported $32 billion in Medicaid supplemental payments during FY 2010, but the exact amount of such supplemental payments is unknown because state reporting was incomplete. For instance, states reported

On July 24, 2012, CMS published a series of notice announcing federal funding levels for various health programs. The first notice sets forth the states’ final allotments available to pay the Medicare Part B premiums for Qualifying Individuals (QIs) for federal FY 2011 and the preliminary QI allotments for FY 2012. Second, CMS has announced

On February 22, 2012, President Obama signed into law H.R. 3630, the Middle Class Tax Relief and Job Creation Act, which was approved by Congress on February 17. In addition to extending a payroll tax cut through the end of the year and extending unemployment benefits, the new law includes a number of Medicare and Medicaid provisions, including a provision temporarily averting a steep cut in Medicare physician payments. The following are highlights of the health policy provisions included in H.R. 3630 and accompanying conference report (House Report 112-399).
Continue Reading President Obama Signs Payroll Tax Bill with Medicare/Medicaid Provisions

CMS published a proposed rule on August 3, 2011 that would implement statutory requirements and making technical corrections to various Medicaid and Children’s Health Insurance Program (CHIP) regulatory provisions. Among other things, the proposed rule would: implement a new reconsideration process for administrative determinations to disallow Medicaid claims for federal financial participation (FFP); lengthen the time states

CMS is requiring non-teaching hospitals to submit informational only bills for Medicare Advantage (MA) beneficiaries they treated in FY 2007 and FY 2008 on or before August 31, 2010 and submit a related attestation or before September 15, 2010. This requirement is a follow-up to a 2007 transmittal requiring all hospitals paid under the inpatient prospective payment

CMS published a notice April 23, 2010 announcing the final FY 2008 and the preliminary FY 2010 federal share disproportionate share hospital (DSH) allotments and limitations on aggregate DSH payments that states may make to institutions for mental disease and other mental health facilities. In addition, the notice includes the revised preliminary federal share DSH