CMS Issues Proposed IPPS Rule

The Centers for Medicare & Medicaid Services (CMS) has released its proposed inpatient prospective payment system (IPPS) rule for fiscal year 2023, with changes that would impact reporting used to calculate Medicare disproportionate share hospital (DSH) payments, limit the types […]

FMAP-Enhanced DSH Allotments Announced

CMS published a Federal Register Notice on March 16, 2022 implementing a congressionally-mandated increase in Medicaid Disproportionate Share Hospital (DSH) allotments for FYs 2020 and 2021 to account for the enhanced federal Medicaid matching rates during the public health emergency. […]

Avoid Unexpected Medicaid DSH Recoupments Under New Hospital-Specific Limit Rules

The rules governing how to treat costs and revenues for hospital services provided to dually-eligible Medicaid patients for purposes of calculating the limit on Medicaid disproportionate share hospital (DSH) payments to a particular hospital have been repeatedly modified in the […]

CMS Releases State Medicaid Director Letter with Guidance on Implementation of Supplemental Payment Reporting and DSH Limit Provisions in Consolidated Appropriations Act of 2021

In a State Medicaid Director Letter (SMDL) dated December 10, 2021, the Centers for Medicare & Medicaid Services (CMS) issued guidance on how the agency will implement several Medicaid-related provisions from the Consolidated Appropriations Act of 2021 (CAA). As of […]

Congress Delays and Reduces DSH Allotment Cuts, Alters Treatment of Patients with Third-Party Coverage in Calculating the Hospital-Specific DSH Limit

The Consolidated Appropriations Act of 2021 (CAA) contains two important changes impacting Medicaid disproportionate share hospital (DSH) payments. First, the CAA once again delays Medicaid DSH cuts mandated by the Affordable Care Act, extending $8 billion in annual cuts until […]

Fifth Circuit Upholds CMS Third Party Payer Rule in DSH Litigation

On April 20, The U.S. Court of Appeals for the Fifth Circuit became the third appeals to court to reinstate CMS’ 2017 final rule requiring states to include Medicare and commercial payments in their Medicaid DSH limit calculations. The rule […]

Petition for Certiorari Filed in CHAT DSH Litigation

On April 6, 2020, a petition for writ of certiorari was filed in the DSH litigation case of Children’s Hospital Association of Texas v. Azar.

Senate Approves Temporary Delay in DSH Cuts

On September 26, 2019, the Senate approved a bipartisan continuing resolution to temporarily delay $4 billion in cuts to Medicaid disproportionate share hospital (DSH) payments. The cuts, originally set to take place on October 1, will now take effect on […]

CMS Issues Final Rule on DSH Cut Methodology

On September 23, 2019, CMS issued a final rule implementing its Disproportionate Share Hospital (DSH) reduction methodology. The DSH payment cuts were part of the Affordable Care Act (ACA) and are currently scheduled to begin in 2020 after a series […]

Despite Early Success for Providers, August 2019 Appellate Court Decision Leaves Future Uncertain for Medicaid DSH Third-Party Payer Policy

Over the last several years, courts in various jurisdictions have issued rulings in lawsuits challenging the Centers for Medicare & Medicaid Services’ (CMS’) policy requiring the inclusion of Medicare and commercial payments in the calculation of the Medicaid disproportionate share […]