AAMC Urges Supreme Court to Correct HHS Misinterpretation of DSH Formula

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 an Aug. 14 amicus brief (PDF)asking the Supreme Court to correct a "misinterpretation" by the Department of Health and Human Services (HHS) regarding application of the formula for calculating disproportionate share hospital (DSH) payments.

The lawsuit, Advocate Christ Medical v. Becerra, was originally filed in 2017 by a group of more than 200 hospitals over the agency's formula for calculating 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 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. Additionally, it explains that the 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. It argues that the HHS should include patients in the numerator that are eligible for SSI (not only those who receive cash payments).

The AAMC and the other hospital associations filed an amicus brief at the cert petition stage in February urging the Supreme Court to review the case [refer to Washington Highlights, Feb. 9].