The Supreme Court granted a request on June 10 to review a case, Advocate Christ Medical Center, et al. v. Becerra, that challenges how the Department of Health and Human Services (HHS) applies the formula for calculating disproportionate share hospital (DSH) payments. In February, the AAMC joined the American Hospital Association, America’s Essential’s Hospitals, the Federation of American Hospitals, the National Rural Health Association, and the Catholic Health Association in submitting a brief (PDF) to the Supreme Court asking the justices to review the case [refer to Washington Highlights, Feb. 9].
Specifically, the DSH formula has a Medicare fraction that includes the Supplemental Security Income (SSI) entitled Medicare population in the numerator and the total Medicare population in the denominator. The HHS has implemented a policy stating that a patient is included in the numerator only if that patient actually received cash SSI payments during their hospital stay. The brief argued that the HHS interpretation is incorrect and results in an estimated loss in DSH payments of about $1 billion per year. It argued that the agency should include patients in the numerator who are eligible for SSI (not only those who receive cash payments). The brief also explained that a hospital’s eligibility for DSH payments affects its entitlement to other benefits designed to help hospitals provide a wide range of services, such as the 340B Drug Pricing Program. Therefore, the HHS’ incorrect interpretation has a significant impact on hospitals and the patients they treat.