AHA, FAH seek more changes to DSH ‘unin­sured’ def­i­ni­tion

Modern Healthcare - - LATE NEWS -

The Amer­i­can Hospi­tal As­so­ci­a­tion and the Fed­er­a­tion of Amer­i­can Hos­pi­tals say the CMS’ pro­posed changes on how of­fi­cials de­fine “unin­sured” when com­put­ing Med­i­caid dis­pro­por­tion­ate-share hospi­tal pay­ments still need tweak­ing. Un­der a pro­posed rule is­sued Jan. 18, the CMS would con­sider whether pa­tients were cov­ered for the spe­cific ser­vices pro­vided by a hospi­tal rather than deem­ing pa­tients in­sured if they have any ac­tive in­sur­ance cov­er­age. It also would ac­count for ser­vices that in­sur­ers don’t re­im­burse be­cause they ex­ceed a pol­icy’s an­nual or life­time lim­its. The two hospi­tal trade groups said in sep­a­rate com­ment let­ters that the CMS should clar­ify the rule to in­clude the cost of un­com­pen­sated care given when health in­sur­ance ben­e­fits run out dur­ing an ex­tended hospi­tal stay. The groups expressed con­cern that the rule ex­cludes un­re­im­bursed costs for ser­vices pro­vided to pa­tients un­der the In­dian Health Ser­vice and tribal health pro­grams. They also said the DSH cal­cu­la­tion should re­flect un­re­im­bursed hospi­tal ser­vices ad­min­is­tered by doc­tors, as well as debts of pa­tients with high-de­ductible health plans who can’t af­ford their co­pay­ments and de­ductibles. The groups asked that the re­vi­sions to the cal­cu­la­tion be ap­plied retroac­tively to fis­cal 2009.

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