DSH payments are calculated by combining two fractions. The first fraction considers days spent in the hospital by patients eligible for Medicare Part A and Supplemental Security Income, while the second accounts for days spent by patients who qualify for a state Medicaid plan but not Medicare Part A. The hospitals allege that HHS’s interpretation of “entitled” under the Medicare DSH statute leads to inconsistencies, reducing their payments.
Courts Side With HHS in Similar Cases
After filing their complaint, the hospitals agreed with HHS to pause the case pending the outcome of a similar dispute, Advocate Christ Medical Center v. Becerra, which was being reviewed by the D.C. Circuit. The U.S. Supreme Court also ruled in favor of HHS in a related case, Becerra v. Empire Health Foundation, slightly under a month after Tarzana filed its lawsuit.
On Thursday, the court issued a brief docket entry denying the hospitals’ request to extend the stay, citing insufficient reason to do so.
HHS Hospital Payment Rule Suit : HHS Pushes for Administrative Resolution
HHS maintains that the hospitals’ premature filing prevented the agency’s review board from determining its own jurisdiction or addressing other preliminary issues. According to HHS, the Medicare statute requires that providers who disagree with a DSH reimbursement first seek administrative review, and only then, if unresolved, may they pursue court action.
