The District of Columbia U.S. Court of Appeals has reversed a June 2007 ruling that awarded 25 Ohio hospitals $79 million in a dispute over how they calculated Medicare disproportionate-share payments.
A federal statute calls for hospitals to measure their burden of providing care to low-income patients based on the number of Medicaid-eligible patients they treat. Ohio hospitals had argued successfully in U.S. District Court in Washington that the CMS was wrong to exclude from that calculation patients served under the states Hospital Care Assurance Program, which subsidizes free care provided to indigent patients in part with federal funds claimed through a Medicaid disproportionate-share program.
In an opinion published May 30, Judge Douglas Ginsburg disagrees with the hospitals interpretation, pointing out that HCAP is explicitly directed at easing the burden of caring for low-income patients not eligible for coverage under the state Medicaid program and that the charity care provided doesnt meet the definition of medical assistance under the statute.
The litigation grew out of a finding in favor of the hospitals by the Provider Reimbursement Review Board that was overturned by the CMS, said Charles Cataline, the Ohio Hospital Associations senior director of health policy.
To have come so far and won so many times and have it overturned is a significant disappointment, Cataline said.
Ohio hospitals have continued to claim HCAP days, even though theyre rejected, in order to have them on the record pending the final resolution of this case and a similar one. There are many, many dollars and discharges involved beyond these two cases, Cataline said. -- by Gregg Blesch