Close

November 1, 2017

CMS Finalizes Medicaid DSH Regulations Regarding Treatment of Medicare and Commercial Payments for the Dual Eligibles

The Centers for Medicare & Medicaid Services (CMS) finalized regulations requiring states to include Medicare or commercial payments for services provided to dually eligible Medicaid patients when calculating the hospital-specific limit on DSH payments during annual DSH audits. For some DSH hospitals, this policy significantly decreases the uncompensated care for which they are able to receive payments, and could result or in some cases has resulted in recoupment of payments.

CMS had previously announced this policy through a Frequently Asked Questions document in 2010—a policy that has since been challenged in seven lawsuits across the country, and enjoined by two federal judges.

Eyman Associates continues to track the implications of this final rule for DSH payments to our clients and hospitals across the country, as well as the status of the ongoing legal challenges and the implications of this new rule for enforcement of CMS’ policy.