CMS Releases Guidance on Third Party Payers and Medicaid DSH Payments

August 19, 2020

 

Guidance applies to state plan rate year 2017 disproportionate share hospital payment audits in light of court ruling

 

Sign In to Download the Special Bulletin:
CMS Releases Guidance on Third Party Payers and Medicaid DSH Payments


The Centers for Medicare & Medicaid Services (CMS) yesterday published guidance for states on the treatment of third party payers (TPP) in determining the hospital-specific Medicaid disproportionate share hospital (DSH) payment limits for the state plan rate year (SPRY) 2017 DSH audits. Historically, TPP payments were excluded from the calculation of Medicaid shortfall in determining hospital-specific DSH limits. CMS published a final rule on April 3, 2017 that required states and hospitals to include TPP payments in their calculation of hospital-specific DSH limits. Following legal challenges in several jurisdictions, the United States Court of Appeals for the D.C. Circuit found in favor of CMS and reinstated the final rule.

This guidance notifies states and hospitals that CMS intends to enforce the DSH TPP final rule as it applies to hospital services furnished on or after June 2, 2017. View details under key resources. AHA members must sign in to view. 

 

Related Resources

Advancing Health Podcast
The 5th Circuit Court of Appeals last year ruled the ACA’s individual mandate unconstitutional and sent the case back to the district court in Texas for the…
Action Alert
Member Non-Fed
Congress is back in Washington, D.C., for its “lame-duck” session, in which lawmakers will take up pressing, end-of-year business. Funding for the federal…
Advisory
The Centers for Medicare…
Action Alert
Member
The Medicaid Disproportionate Share Hospital (DSH) program provides financial assistance to hospitals serving a disproportionate number of low-income patients…
Special Bulletin
Public
The House Appropriations Committee today released a continuing resolution that, in general, extends current government funding levels through Dec. 11.
Advisory
Public
Sign In to Download the Regulatory Advisory: Medicare Physician Fee Schedule: Proposed Rule for CY 2021