Hackensack hospitals sue HHS over DSH payments
The lawsuit was filed the same day the Supreme Court ended the Chevron doctrine, which protected federal regulations from legal challenges.
Photo: Courtesy of Hackensack
Hackensack Meridian Health is suing Health and Human Services Secretary Xavier Becerra over the calculation of Medicare reimbursement used to determine Disproportionate Share Hospital payments.
The Centers for Medicare and Medicaid Services calculations left out more than 400 patients, which reduced the amount of reimbursement Hackensack hospitals were paid, according to the lawsuit filed on June 28, the same day that the Supreme Court ruled 6-3 against the long-standing Chevron decision.
Chevron is the bigger picture in the Hackensack lawsuit, as the Supreme Court decision ended a Reagan-era doctrine that for decades protected legal challenges to federal regulations, according to Politico. The ruling is considered a victory for conservatives.
Hackensack's complaint was filed on June 28 in federal court for the District of Columbia by Hackensack University Medical Center, Jersey Shore University Medical Center and Raritan Bay Medical Center.
It addresses determinations of the hospitals' Medicare payment for 2016.
WHY THIS MATTERS: WHAT THIS MEANS
Hackensack is challenging Becerra on the calculation for DSH payments that are based on a formula or metrics that includes the number of qualifying patients, the amount of Social Security supplemental security income (SSI) and inpatient days.
CMS doesn't provide the data for the calculations, only the end result, Hackensack said.
Hackensack wants the court to compel CMS to disclose the hospital patient-level SSI-eligibility data obtained from the Social Security Administration and to rule that CMS's interpretation of entitled SSI benefits is contrary to the Medicare statute.
Becerra's, "Irrational and unlawful interpretation of the statutes he is entrusted to administer – which has deprived the hospitals of the reimbursements they are due – along with his refusal to enable the hospitals to effectively employ the congressionally mandated procedures for obtaining relief from these underpayments," the complaint said.
During the rulemaking for the 2005 final rule, some commenters urged CMS to release the full SSI-eligibility data file provided by the Social Security Administration, the lawsuit said. CMS responded by asserting that under its data use agreement, CMS is "strictly prohibited from disclosing SSI eligibility information," while SSA is in turn prohibited from disclosing this information by "federal law and regulations."
Because the hospitals could not get SSI data, they used information from the New Jersey Medicaid agency. The agency received the data directly from SSA. From this Hackensack determined that CMS left 408 patients left out of the calculations.
Among its requests to the court, the hospitals want the court to hold unlawful and set aside CMS's calculation of the hospitals' SSI fractions used in DSH calculations for FY 2016.
THE LARGER TREND
Disproportionate share hospital payments give hospitals that serve an unusually high percentage of low-income patients' enhanced Medicare reimbursement.
The DSH adjustment is made because low-income individuals are generally more expensive to treat than higher-income patients, even for the same medical conditions, the lawsuit said.
Email the writer: SMorse@himss.org
