Eighty hospitals are seeking to have the Part C (Medicare Advantage) Days Final rule vacated, alleging that HHS unlawfully reduced disproportionate hospital share payments by an estimated $3 billion to $4 billion over a nine-year period.
Five things to know:
1. The eighty hospitals, which include those owned by Cleveland Clinic, are suing HHS in Washington, D.C., federal court.
2. In June 2023, CMS issued the Part C Days Final Rule. That rule finalized a proposal to include Medicare Advantage patient days in the Medicare Fraction, retroactive to before Oct. 1, 2013.
3. In the lawsuit, the hospitals allege that CMS' justifications for retroactive rulemaking are unsupported by Supreme Court decisions and contrary to the Medicare statute.
4. The hospitals are seeking to order HHS to calculate the Medicare Fraction without including Medicare Advantage Days.
5. The hospitals are also seeking a reversal of denied appeals with the Provider Reimbursement Review Board.
HHS did not immediately return a message seeking comment.