AHA files brief in Supreme Court urging correction of HHS undercounting of SSI-eligible recipients in DSH formula

The AHA, joined by five other national hospital associations, Aug. 14 filed an amicus brief urging the Supreme Court to correct the Department of Health and Human Services' misinterpretation of the formula set by Congress to calculate Disproportionate Share Hospital (DSH) payments, which includes a Medicare fraction that counts supplemental security income-eligible Medicare beneficiaries in the numerator and the total Medicare-eligible population in the denominator. The AHA said that HHS is 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, resulting in smaller payments.

HHS' interpretation undermines the DSH program, AHA said, and is inconsistent with a previous Supreme Court ruling in Becerra v. Empire Health Foundation in which HHS successfully argued that a patient is "entitled to" Medicare under the DSH formula if they are qualified for Medicare, regardless of whether Medicare paid for the hospital stay. "But despite that victory, HHS has refused to apply the same logic to determine whether a patient is 'entitled to' SSI benefits - even though Congress used the same words in the same sentence," the brief notes. "That approach is textually indefensible, and it significantly undercounts the needy patients served by America's hospitals." If this misinterpretation stands uncorrected, hospitals are estimated to lose more than a billion dollars annually in DSH payments, according to the brief. "What's more, a hospital's eligibility for DSH payments affects its entitlement to other federal benefits designed to help hospitals 'provide a wide range of medical services' to vulnerable populations," the brief added.

The Association of American Medical Colleges, America's Essential Hospitals, the Catholic Health Association, the Federation of American Hospitals and the National Rural Health Association joined AHA in the filing. The AHA and fellow amici filed an amicus brief at the cert petition stage in February advocating for the Supreme Court to take up the issue for review.