Archive for Medicare disproportionate share

 

Federal Health Policy Update for October 6

The following is the latest health policy news from the federal government for the week of September 26 to October 6.  Some of the language used below is taken directly from government documents.

340B

  • HHS must immediately end its significant cut in reimbursement for 340B-covered prescription drugs provided on an outpatient basis to eligible patients, a federal court has ruled, writing that “The prospective portion of the 2022 reimbursement rate shall be vacated because it is defective and because vacating this portion of the 2022 OPPS Rule will not cause substantial disruption” and that “HHS should not be allowed to continue its unlawful 340B reimbursements for the remainder of the year just because it promises to fix the problem later.”  Learn more from this federal district court decision.
  • In response to this ruling, HHS shared its plan for responding to the court order by restoring a payment rate of average sales price plus six percent for 340B-covered drugs.  In a brief to the court it explained that “…the process of adjusting the 2022 OPPS payment rates for 340B hospitals would take approximately two weeks” because it “requires revisions to four different electronic data files and then testing by multiple

Court Rejects Long-Running Medicare DSH Challenge

In a case that challenged a 2005 change in how the federal Centers for Medicare & Medicaid Services calculates Medicare disproportionate share (Medicare DSH) payments, the Supreme Court has, in a 5-4 decision, reversed a lower court ruling and upheld CMS’s policy of counting days of care for which Medicare does not pay in the Medicare fraction of the Medicare DSH percentage – a policy change widely viewed as disadvantageous to hospitals that care for larger numbers of low-income patients.

This means that Medicare exhausted days and days of care provided to Medicare enrollees with another source of third-party coverage count in the numerator and denominator of the Medicare fraction.  In most cases this results in a lower percentage of a hospital’s Medicare patients also being eligible for SSI and the lowering of that ratio, thereby reducing the amount of Medicare DSH payments a hospital receives.

For most hospitals this ruling has the effect of closing the door on a potential payment increase rather than reducing expected payments.

Learn more from the Fierce Healthcare article “Supreme Court sides with HHS over Medicare DSH rule dispute in blow to hospitals,” the SCOTUS blog analysis “Divided court sides with

Federal Health Policy Update for Monday, June 27

The following is the latest health policy news from the federal government as of 2:15 p.m. on Monday, June 27.  Some of the language used below is taken directly from government documents.

White House

The White House COVID-19 response team has briefed the press about the administration’s latest efforts in the response to COVID-19.  Find a transcript of that briefing here and find the slides presented during that briefing here.

Supreme Court

In a case that challenged a 2005 change in how CMS calculates Medicare disproportionate share (Medicare DSH) payments, the Supreme Court has, in a 5-4 decision, reversed a lower court ruling and upheld CMS’s policy to count days of care for which Medicare does not pay in the Medicare fraction of the Medicare DSH percentage – a policy change widely viewed as disadvantageous to hospitals that care for larger numbers of low-income patients.  This means that Medicare exhausted days and days of care provided to Medicare enrollees with another source of third-party coverage count in the numerator and denominator of the Medicare fraction.  In most cases this results in a lower percentage of a hospital’s Medicare patients also being eligible for SSI and the lowering of that …

Federal Health Policy Update for Thursday, March 10

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, March 10.  Some of the language used below is taken directly from government documents.

White House

340B Eligibility Protection and Telehealth Extensions in the Omnibus Spending Bill

Providers that feared they might lose their eligibility to continue participating in the 340B prescription drug discount program because they have fallen below that program’s Medicare disproportionate share (Medicare DSH) threshold will remain eligible for the program at least through their next reporting period.

The following is a summary of the telehealth flexibilities extensions included in this bill, which passed in the House yesterday and is expected to pass in the Senate this weekend.

  • Patients will be permitted to continue receiving telehealth services at any site at which they are located, including their homes, for 151 days beginning on the first day after the public health emergency (PHE) formally ends.
  • This applies to all services that are considered payable under the Medicare physician fee schedule at the

Federal Health Policy Update for Thursday, August 5

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, August 5.  Some of the language used below is taken directly from government documents.

Final Medicare Inpatient Prospective Payment System Regulation for FY 2022

CMS has published its final Medicare inpatient prospective payment system regulation for FY 2022.  Highlights include:

  • An increase in hospital inpatient rates of 2.5 percent and an increase in long-term hospital rates averaging 0.9 percent.
  • The Medicare disproportionate share (Medicare DSH) payments uncompensated care allocation has been cut $1.1 billion, to $7.2 billion, with distribution to be based on hospitals’ FY 2018 Medicare cost reports.
  • A reduction of the labor-related share of Medicare payments from 68.3 percent to 67.6 percent.
  • Repeal of the requirement that hospitals report median payer-specific negotiated charges with Medicare Advantage plans on their Medicare cost reports.
  • Extension of the COVID-19 treatment add-on payment through the end of the fiscal year in which the public health emergency ends.
  • A new requirement that hospitals include in their Medicare quality program reporting information about the vaccination status of their staffs.

CMS noted that this regulation is not comprehensive and that it will issue an additional regulation or …