Uncertainty On Hospital Disproportionate Share Pay Eligibility


Stuart M. Gerson and Robert E. Wanerman, Members of the Firm in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office have co-authored an article in Law360, titled “Uncertainty On Hospital Disproportionate Share Pay Eligibility.” (Read the full version – subscription required).

Following is an excerpt:

Hundreds of hospitals may have had their hopes of receiving additional reimbursement from Medicaid dashed as a result of a recent decision of the U.S. Court of Appeals for the District of Columbia Circuit. But, at least for now, hospitals can enjoy some optimism with respect to additional Medicare reimbursement as the result of the U.S. Supreme Court’s affirmance of another decision of the D.C. Circuit, Azar v. Allina Health Services.

The uncertainty involves when and how a hospital can qualify to receive disproportionate share hospital, or DSH, payments when it provides services to low-income patients. Under current circumstances, hospitals can claim one win and one loss, but until the remand of the Allina case is ultimately resolved, some hospitals very well might go zero for two. The current uncertainty necessarily affects hospitals’ estimates of the net impact on their DSH reimbursements and how that could affect their overall operations.