The Centers for Medicare & Medicaid Services (CMS) has issued a final rule implementing the agency’s methodology for making statutory reductions to Medicaid disproportionate share hospital (DSH) allotments. The DSH allotment reductions apply to fiscal years (FY) 2020 through 2025, with a $4 billion reduction applicable in FY 2020 and an $8 billion reduction applicable
CMS has proposed regulatory changes to specify that the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments is based on uncompensated care costs net of third-party payments received. Under the proposed rule – which is intended to align with CMS’s existing interpretation – a hospital’s uncompensated care costs would not include care provided to Medicaid-eligible individuals for which the hospital received third party payments, such as payments from Medicare or private insurance. Therefore the hospital-specific limit calculation would reflect only the costs for Medicaid eligible individuals for which the hospital has not received payment from any source (other than state or local governmental payments for indigent patients).
Continue Reading CMS Proposes Clarification of Treatment of Third Party Payments in Calculating Uncompensated Care Costs under Medicaid DSH Payments Rules
On January 18, 2012, CMS published a proposed rule that would define “uninsured” for purposes of calculating the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments. The proposed rule would not modify state DSH allotment amounts. CMS will accept comments on the proposal until February 17, 2012.