Six national hospital groups, including the American Hospital Association, America's Essential Hospitals and the Federation of American Hospitals, on Aug. 14 filed an amicus brief urging the Supreme Court to correct HHS' "misinterpretation" of the formula set by Congress to calculate Disproportionate Share Hospital payments.
As it stands, the DSH pay formula includes a Medicare fraction that counts supplemental security income-eligible Medicare beneficiaries in the numerator and the total Medicare-eligible population in the denominator.
The AHA argues that HHS is "undercounting" the number of SSI-eligible Medicare beneficiaries by claiming patients are "entitled to" SSI benefits only if they actually receive those benefits, which lowers the numerator in the formula and results in lower payments to hospitals.
HHS' interpretation is inconsistent with a previous Supreme Court ruling (Becerra v. Empire Health Foundation) in which HHS argued that a patient is "entitled to" Medicare under the DSH formula if they are qualified for Medicare — regardless of whether Medicare paid for the hospital stay.
"Despite that victory, HHS has refused to apply the same logic to determine whether a patient is 'entitled to' SSI benefits — even though Congress used the same words in the same sentence," hospitals groups said in the amicus brief. "That approach is textually indefensible, and it significantly undercounts the needy patients served by America's hospitals."
If the DSH pay formula is not adjusted, hospitals are projected to lose more than a billion dollars a year in DSH payments, according to the AHA.
"What's more, a hospital's eligibility for DSH payments affects its entitlement to other federal benefits designed to help hospitals 'provide a wide range of medical services' to vulnerable populations," the hospital groups wrote in the brief.
The Association of American Medical Colleges, Catholic Health Association and National Rural Health Association also joined in the filing.
Click here to read the amicus brief in full.