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...
Coronavirus Resources
This page collects some of the COVID-19-related federal laws, regulations and guidance that is most relevant to Eyman Associates’ clients and friends. Please feel free to reach out to any of our team members to help you navigate these complex policies during this...
340B Drug Discount Program
HRSA Office of Pharmacy Affairs Program Website Law and Guidance Section 340B of the Public Health Service Act Selected Critical Guidance NEW: Proposed OPPS Rule, 340B Excerpt (July 20, 2017) NEW: OPA Withdrawal of Omnibus Guidance (Jan. 2017) 340B Drug Pricing...
DSRIPs and Related Programs
At Eyman Associates, we monitor developments in the use of 1115 waiver demonstrations to support delivery system transformation on an ongoing basis and strive to provide the most current and thorough information possible for our clients. Current Program: Public...
Uncompensated Care Pools
A number of state Medicaid programs have received approval under 1115 demonstration authority for funding pools to compensate providers for the uncompensated costs of serving Medicaid and uninsured individuals, in particular to ensure sufficient support for certain...
Medicaid Managed Care
Key Resources on Medicaid Managed Care CMS Published Rules and Regulations Proposed Rule on New Pass-Through Payments CMS 2016 Final Medicaid Managed Care Rule CMS 2015 Proposed Medicaid Managed Care Rule CMS 2002 Final Medicaid Managed Care Rule CMS 2001 Proposed...
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,...
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...
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...
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...
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...
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 was recently reinstated on...
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 November 22nd.
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 of two-year delays....
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...
DHS Issues Final Rule on Public Charge
On August 14, 2019, the Department of Homeland Security (DHS) issued a final rule expanding the types of public benefits that may be considered when assessing whether an individual is a “public charge” for purposes of altering their immigration status. The rule allows...
D.C. Circuit Reverses Lower Court’s Ruling in DSH Litigation
On August 13, 2019, the D.C. Circuit issued its highly-anticipated decision in a lawsuit brought by the Children’s Hospital Association of Texas (CHAT) and others, challenging the legality of CMS’ 2017 Medicaid DSH third-party payer final rule that was set to take...
MACPAC Provides Recommendations on DSH “Medicaid Shortfall” Calculation
In its June 2019 report to Congress on Medicaid and CHIP, the Medicaid and CHIP Payment and Access Commission (MACPAC) recommended that Congress modify the Medicaid shortfall portion of the disproportionate share hospital (DSH) limit calculation to exclude costs and...
MACPAC Releases Recommendations on Medicaid DSH Cuts
On March 18, 2019, MACPAC published its recommendations for restructuring the Medicaid disproportionate share hospital (DSH) program. In its March 2019 Report to Congress, MACPAC outlined three recommendations for minimizing the impact of DSH cuts on safety net...
CMS Withdraws FAQs 33 & 34 Amidst Ongoing DSH Litigation
As of December 30, 2018, CMS has withdrawn its policy on the inclusion of third party payments in calculating the disproportionate share hospital (DSH) limit. FAQs 33 & 34 require that states include commercial and Medicare payments, respectively, in their DSH...
6th Circuit Affirms District Court Ruling On Medicaid DSH FAQs While Upholding Underlying Policy
On November 14, 2018, in a 2-1 decision, the 6th Circuit affirmed a summary judgment ruling that CMS Medicaid DSH third party payer FAQs are procedurally invalid, while holding that CMS has the statutory authority to require the inclusion of Medicare and commercial...
Supreme Court Agrees to Hear $4B Medicare DSH Case
On September 27, 2018, the Supreme Court granted certiorari in Azar v. Allina Health Services, et al. The Court will hear arguments on whether HHS was required to go through notice and comment before implementing a rule that altered the Medicare reimbursement formula...
CMS Files Appeal to 8th Circuit on Final Rule in DSH Lawsuit
On April 10, 2018, CMS filed a notice of appeal to the 8th Circuit in the litigation of Missouri Hospital Association v. Price. This will be the first appellate court to hear arguments on the April 2017 Final Rule. It follows a First Circuit ruling earlier this month...