The American Hospital Association and the Federation of American Hospitals say the CMS’ proposed changes on how officials define “uninsured” when computing Medicaid disproportionate-share hospital payments still need tweaking.

Under a proposed rule issued Jan. 18, the CMS would consider whether patients were covered for the specific services provided by a hospital rather than deeming patients insured if they have any active insurance coverage. It also would account for services that insurers don’t reimburse because they exceed a policy’s annual or lifetime limits. The two hospital trade groups said in separate comment letters that the CMS should clarify the rule to include the cost of uncompensated care given when health insurance benefits run out during an extended hospital stay.

The groups expressed concern that the rule excludes unreimbursed costs for services provided to patients under the Indian Health Service and tribal health programs. They also said the DSH calculation should reflect unreimbursed hospital services administered by doctors, as well as debts of patients with high-deductible health plans who can’t afford their copayments and deductibles. The groups asked that the revisions to the calculation be applied retroactively to fiscal 2009.