On Tuesday, the Centers for Medicare and Medicaid Services (CMS) released its final Fiscal Year 2018, Fiscal Year 2019, Preliminary Fiscal Year 2020 and Preliminary Fiscal Year 2021 Disproportionate Share Hospital Allotments and limits for Institutions for Mental Diseases.
Disproportionate Share Hospital Allotments (DSH) are calculated retrospectively each year for further payments to hospitals that see a higher than average number of Medicaid patients. Numerous lawsuits have been filed by hospitals against the Department of Health and Human Services. Plaintiffs in these suits take issue with pricing methods that have been used to implement the modification, including several calculations that resulted in smaller payment amount for Medicare Part C coverage.
that the agency is calculating payments from 2013 and 2014 based on an older regulatotion, which has been struck down as arbitrary and capricious.
The amount of the allotment is calculated according to Section 1923(f) of the Social Security Act, however many interim bills and orders have had substantial impact on the calculation method and have required retrospective recalculation of the amounts.
These recalculations include: 1. Section 1923(f)(7), which would have required a gradual reduction to states fiscal year DSH allotments from Fiscal Year 2014 through Fiscal Year 2020, which was later delayed to 2024 by the Affordable Care Act and 2. The Families First Coronavirus Response Act (FFCRA) which temporarily increased federal medical assistance including DSH by 6.2 percent.
Because the DSH payments are calculated retrospectively including up to 2 years previous, the DSH numbers posted in the release include preliminary but not final number for 2020 and 2021 which can be modified through the end of 2022. The release also includes a table of DSH rates by state.
