Supreme Court sides with HHS in Medicare DSH formula case

The Supreme Court April 29 ruled 7-2 in favor of the Department of Health and Human Services in a case that challenged how HHS applied Congress’ formula for calculating Medicare Disproportionate Share Hospital payments. The formula includes a fraction that counts supplemental security income-eligible Medicare beneficiaries in the numerator and the total Medicare-eligible population in the denominator. The court upheld HHS’s longstanding position that if a patient is ineligible for a monthly cash benefit under SSI, a hospital cannot count that person towards the SSI portion of its DSH fraction.  
 
The AHA last year filed an amicus brief in the case, arguing that HHS was undercounting the number of SSI-eligible Medicare beneficiaries by claiming patients are “entitled to” SSI benefits only if they actually receive SSI benefits, which lowers the numerator in the formula and results in smaller payments.