The House Energy and Commerce Health Subcommittee held a hearing, “Legislative Proposals to Increase Medicaid Access and Improve Program Integrity.” During the hearing, subcommittee members received testimony from Daniel Tsai, deputy administrator and director of the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicaid and CHIP Services.
In a key exchange, Rep. Larry Bucshon, MD (R-Ind.) raised concerns regarding Sec. 203 of the Consolidated Appropriations Act, 2021 (P.L. 116-260), which prohibits hospitals from accounting for costs and revenues associated with Medicaid enrollees who qualify for third-party coverage (including Medicare) when calculating their disproportionate share hospital cap [refer to Washington Highlights, Feb. 23]. “This policy has resulted in unintended consequences that have negatively impacted hospitals in my district and across the country, many of whom treat our most vulnerable constituents,” he stated.
While Sec. 203 currently provides an exemption for hospitals that are at or above the 97th percentile with respect to the number of Medicare supplemental security income (SSI) days or the ratio of SSI days to total inpatient days, Bucshon highlighted concerns that this methodology failed to capture many small rural and safety-net hospitals across the state of Indiana, thereby risking their closure. In his response, Tsai noted that Sec. 203’s statute was “exceedingly clear,” leaving “no policy direction for CMS.” Regardless, he committed to working with Bucshon on this issue.