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Contact: John Parker, 202-828-0975, jparker@aamc.org
Hospital Groups Join Forces to Uphold Provider Right to Sue for State Medicaid Reimbursement
Washington, D.C., May 31, 2000--The Nine hospital groups-whose members rely on state Medicaid reimbursement to serve an estimated 40 million Medicaid recipients and 44 million uninsured Americans-have submitted an amicus brief to the U.S. Supreme Court, upholding their ability to provide essential healthcare services to America's poor, underinsured and uninsured.
Hospital providers serving Medicaid patients depend on fair, comprehensive, mandated state reimbursement, including disproportionate share hospital (DSH) payments, to fulfill the mission with which they have been charged. A finding by the Third Circuit of the U.S. Court of Appeals in Children's Seashore House v. Waldman has endangered this requirement and compromises DSH providers' ability to deliver such care.
DSH provisions require states to make supplemental Medicaid payments to hospitals serving a disproportionate share of Medicaid and uninsured patients. Congress has strengthened the program since its 1981 inception-in clear recognition that underpayment for Medicaid patients threatened the very survival of these hospitals.
The hospital groups-the National Association of Children's Hospitals, National Association of Public Hospitals and Health Systems, Association of American Medical Colleges, American Hospital Association, VHA, Inc., Premier, National Association of Urban Critical Access Hospitals, Catholic Health Association and California Association of Public Hospitals and Health Systems-have filed the brief in support of the plaintiff's petition for certiorari to the Court.
Parties to the brief maintain that Medicaid law grants disproportionate share hospitals a right of action against states that refuse to comply with the DSH payment provisions. Consequently, these hospital groups find the Third Circuit's failure to find an enforceable right in Children's Seashore House v. Waldman, contradicting Supreme Court precedent, is especially troublesome. The ability of providers to collect DSH payments is vital to the preservation of a program that serves as a healthcare safety net for some of our nation's most vulnerable populations. The Third Circuit's decision challenges basic DSH requirements, devised and enacted by Congress to maintain a strong and enforceable Medicaid DSH payment program.
"It's impossible to overemphasize the importance of Medicaid DSH payments for our nation's safety net hospitals," said Lawrence A. McAndrews, president and CEO of the National Association of Children's Hospitals. "These institutions are the major providers of primary, preventive, specialty and trauma care for untold numbers of poor, uninsured and underinsured Americans. The survival of the Medicaid DSH program and safety net hospitals depend on the enforcement of mandated state support."
As an Institute of Medicine report, "America's Health Care Safety Net: Intact but Endangered," concluded, resources to cover safety net hospitals' unreimbursed care are meager and increasingly scarce. McAndrews further notes that the DSH payment program confers rights that the Health Care Financing Administration (HCFA), the federal agency charged with the administration and oversight of the Medicaid program, does not actively oversee. "Providers must have legal recourse to bring such rights to fruition," he said. The parties to the brief eagerly await the Supreme Court's decision.
The submission of the amicus brief is emblematic of these hospitals groups' ongoing commitment to preserving and strengthening the Medicaid DSH program, and reflects the larger, overarching campaign to secure provider relief from the unintended consequences of the 1997 Balanced Budget Act. This year, four bipartisan initiatives introduced in the House and Senate would maintain state Medicaid DSH allotments at FY 2000 levels. To date, these measures have secured 170 and 17 co-sponsors, respectively.
CONTACTS:
Charles Luband, Counsel
National Association of Public Hospitals
202.624.7215Suzanne M. Hansen, Director of Medicaid and State Policy
Gillian Ray, Communications Associate
National Association of Children's Hospitals
703.684.1355John Parker, Director of Public Relations
Association of American Medical Colleges
202.828.0975Dionne Dougall, Senior Associate Director, Media Relations
American Hospital Association
202.626.2284Jaime Uranga, Editorial Services Manager
Premier, Inc.
202.879.8014###
The Association of American Medical Colleges represents the 125 accredited U.S. medical schools; the 16 accredited Canadian medical schools; some 400 major teaching hospitals, including 74 Veterans Administration medical centers; 91 academic and professional societies representing nearly 88,000 faculty members; and the nation's 67,000 medical students and 102,000 residents. Additional information about the AAMC and U.S. medical schools and teaching hospitals available at www.aamc.org/newsroom.
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