"The complaint focuses on a CMS policy finalized in 2024 that treats patients covered by Medicare Advantage differently depending on which part of the DSH formula is being calculated. Under the rule, these patients are counted when calculating the Medicare portion of a hospital's DSH payments but ignored when calculating the Medicaid portion, which makes hospitals look like they serve fewer low-income patients than they actually do."
"Hospitals are saying this artificially lowers their total DSH payments, which in turn decreases the funding meant to offset the costs of caring for vulnerable Americans. Overall, they contend that the rule creates a mismatch between the fractions - as well as unfairly penalizes hospitals that serve a disproportionate share of low-income and uninsured patients."
A lawsuit has been filed by 131 hospitals against HHS Secretary Robert F. Kennedy Jr. regarding CMS payment calculations. The hospitals argue that CMS is wrongfully reducing billions in payments for those serving vulnerable populations. The complaint claims that a 2024 CMS policy miscalculates Medicare disproportionate share hospital payments by treating Medicare Advantage patients differently, leading to lower DSH payments. This reduction negatively impacts hospitals' ability to care for low-income patients. The plaintiffs seek to recover withheld payments and revise CMS policy to reflect actual patient care.
Read at MedCity News
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