North Carolina hospitals sue feds for DSH money

Cone Health's Urgent Care Center in Kernersville, North Carolina, via Facebook.

A number of hospitals in North Carolina are suing the federal government over more than $2 million in disproportionate share payments they say they are owed due to changes to the Affordable Care Act.

Cone Health in Greensboro is among the health systems challenging the Centers for Medicare and Medicaid, according to a released statement from the provider.

Cone Health contends it should have received an additional $2.2 million last year from CMS under a revised disproportionate share formula, as first reported by the Triad Business Journal.

“Because of the vague and general drafting of legislation, and the ACA in particular, CMS is given discretion over a lot of technical calculations that can have a large impact on provider payments,” Cone Health said in a statement. “As we understand it, CMS’s goal is to interpret these calculations in a way that minimizes Medicare outlays. This means that healthcare systems, as a routine matter, challenge these interpretations to ensure transparency, rigor, and a collective provider voice in these determinations. And the vehicle to do this is typically group appeals such as this.”

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No other information, including the identity of the other hospitals involved in the appeal, was immediately available.

Hospitals get disproportionate share funds based on the number of uninsured patients they serve. Starting in 2014, the ACA changed the formula for reimbursing hospitals that treat a larger number of indigent patients.

The ACA was intended to reduce the number of uninsured patients by having more people sign up in the exchanges and also through Medicaid expansion. However, North Carolina is among the 19 states that has not expanded Medicaid eligibility and more than 1 million residents in the state are still uninsured.

Twitter: @SusanMorseHFN