(May 1, 2024) - The Centers for Medicare & Medicaid Services issued a final rule regarding the Consolidated Appropriations Act of 2021 which changed the hospital-specific limit on Medicaid disproportionate share hospital payments.
Specifically, Division CC, Title II, section 203 of the CAA 2021 (herein referred to as section 203) amended section 1923(g) of the Act, which describes the methodology for calculating hospital-specific Medicaid DSH limits. This rule will impact hospitals. The CAA 2021 modified section 1923(f) of the Act so reductions will occur from Fiscal Year 2024 through FY 2027, in the amount of $8 billion each year. Since Oct. 1, 2021, the amendments made by section 203 changed the methodology for calculating the Medicaid shortfall portion (Medicaid costs less Medicaid payments) of the hospital-specific DSH limit to only include costs and payments for hospital services furnished to beneficiaries for whom Medicaid is the primary payer.
Additionally, the CAA 2021 provides an exception for certain hospitals in the 97th percentile or above of all hospitals with respect to the number of Medicare Supplemental Security Income days. Those Inpatient days are made up of patients who, for such days, were entitled to Medicare Part A benefits and to SSI benefits or percentage of Medicare SSI days to total inpatient days.