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  • Washington Highlights

    AAMC Joins Brief Urging Supreme Court to Review Reading of DSH Formula

    Gayle Lee, Director, Physician Payment & Quality
    For Media Inquiries

    The AAMC joined the American Hospital Association, America’s Essential’s Hospitals, the Federation of American Hospitals, the National Rural Health Association, and  the Catholic Health Association in submitting a Feb. 2 brief to the U.S. Supreme Court asking the justices to review a case, Advocate Christ Medical Center, et al. v. Becerra, that challenges how the Department of Health and Human Services (HHS) applies the formula for calculating disproportionate share hospital (DSH) payments.  

    Specifically, the DSH formula has a Medicare fraction that includes the Supplemental Security Income (SSI) entitled Medicare population in the numerator and the total Medicare population in the denominator. The HHS has implemented a policy stating that a patient is included in the numerator only if that patient actually received cash SSI payments during the hospital stay. The brief argues that the HHS interpretation is incorrect and results in a loss in DSH payments of about $1 billion per year. It argues that the HHS should include patients in the numerator that are eligible for SSI (not only those who receive cash payments).  

    The brief states that the “HHS’s failure to fully fund the DSH program puts hospitals at risk and makes it more likely that the trend of closures or service cuts will accelerate.” The brief also explains that the hospital’s eligibility for DSH payments affects its entitlement to other benefits designed to help hospitals provide a wide range of services, such as the 340B Drug Pricing Program.