CMS pro­poses change to def­i­ni­tion of unin­sured pa­tients

Modern Healthcare - - LATE NEWS -

The CMS is­sued a pro­posed rule that would rede­fine which hos­pi­tal pa­tients are unin­sured for the pur­pose of cal­cu­lat­ing Med­i­caid dis­pro­por­tion­ate-share pay­ments. The CMS would de­ter­mine whether the pa­tients were cov­ered for the spe­cific ser­vices pro­vided by a hos­pi­tal rather than, as now, deem­ing a pa­tient as in­sured if they have any ac­tive in­sur­ance cov­er­age. The pro­posed change also would add to the DSH cal­cu­la­tion any ser­vice pro­vided that is not cov­ered by an in­sur­ance pol­icy be­cause it ex­ceeds a pol­icy’s an­nual or life­time lim­its. The ex­ist­ing el­i­gi­bil­ity def­i­ni­tions drew ob­jec­tions from hos­pi­tals and state of­fi­cials when they were fi­nal­ized in 2008, the CMS noted in the rule, be­cause in prac­ti­cal ap­pli­ca­tion, so much un­com­pen­sated care was ex­cluded. “We are very pleased the CMS de­cided to de­fine ‘unin­sured’ on a ser­vice-spe­cific ba­sis, rather than an in­di­vid­ual ba­sis,” said Xiaoyi Huang, as­sis­tant vice pres­i­dent for pol­icy at the National As­so­ci­a­tion of Pub­lic Hos­pi­tals and Health Sys­tems. Huang added that three types of costs are still ex­cluded from DSH pay­ments that the or­ga­ni­za­tion would like to see in­cluded: un­paid co­pay­ments and de­ductibles; pay­ments that have been ad­min­is­tra­tively de­nied; and cost of care to pris­on­ers.

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