When it comes to determining what hospitals will receive for their share of Medicare disproportionate-share hospital payments, the CMS is sticking to its guns. That's despite complaints that it may be unfair to some hospitals.
DSH payments are supplementary inpatient payments given to hospitals with high shares of low-income patients and uncompensated care costs. To help calculate payments to providers, the CMS counts a hospital's share of total inpatient days attributable to either a Medicare patient receiving supplemental security income or Medicaid.
In the final Inpatient Prospective Payment rule released last week, the CMS said it will distribute an estimated $6.4 billion in uncompensated care payments in fiscal year 2016, a decrease of $1.2 billion from the estimated fiscal year 2015 amount.
Some providers say the DSH payments are unfairly and politically based.
“Hospitals operating in states that expand Medicaid eligibility will receive a greater portion of the pool than hospitals operating in states in which Medicaid eligibility is not expanded,” Chesterfield, Mo.-based Mercy health system said in a comment on the proposed version of the rule.
“For those hospitals operating in states that did not expand coverage, they will receive a reduction to the national pool based on the national change in the uninsured rate and be penalized a second time due to the number of Medicaid days remaining constant.”
The CMS did not disagree, but said it will continue to calculate DSH payments using this metric.
“We recognize it would be possible for hospitals in states that choose to expand Medicaid to receive higher uncompensated care payments because they may have more Medicaid patient days than hospitals in a State that does not choose to expand Medicaid,” CMS says in the final rule.
“Regardless … we believe that data on insured low-income days remain the best proxy for uncompensated care costs currently available.”
