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HomeHealth LawSCOTUS to Evaluation Case Impacting Medicare Reimbursement for Hospitals Treating Low-Revenue Sufferers

SCOTUS to Evaluation Case Impacting Medicare Reimbursement for Hospitals Treating Low-Revenue Sufferers


On June 10, 2024, the U.S. Supreme Courtroom granted certiorari in Advocate Christ Medical Middle v. Becerra[1] for the October 2024 – 2025 time period to overview a D.C. Circuit Courtroom of Appeals ruling probably affecting as much as $4 billion in federal funding for hospitals.[2] The Supreme Courtroom will decide whether or not the federal Division of Well being and Human Providers (“HHS”) correctly reimbursed hospitals for offering care to sufferers receiving monetary help from the Supplemental Safety Revenue Program (the “SSI Program”).[3] Hospitals benefiting from Medicare reimbursement changes for treating low-income sufferers ought to intently monitor this case, as a positive ruling for the plaintiffs might affect how hospitals are reimbursed for comparable claims sooner or later.

Background

Advocate Christ Medical Middle facilities on how a lot hospitals may be reimbursed for treating low-income Medicare beneficairies.[4] HHS makes mounted funds for companies offered by hospitals to Medicare Half A beneficiaries and adjusts these funds for hospitals that serve an “unusually excessive share of low-income sufferers” as a result of these sufferers usually require extra care.[5] This share is expressed in a fraction (the “Medicare Fraction”) utilizing knowledge from the Social Safety Administration (“SSA”) as to which Medicare sufferers are “entitled to SSI advantages.”[6]

The first SSI Program profit at concern consists of month-to-month money funds made to needy people who’re aged, blind, or disabled (“Money Funds”).[7] People who’re enrolled within the SSI Program should show eligibility every month to obtain Money Funds, however stay enrolled within the SSI Program even when they don’t qualify for Money Funds in a selected month.[8] Every month, for the aim of figuring out the Medicare Fraction, HHS counts solely these people who have been entitled to obtain Money Funds below the SSI Program and doesn’t depend people who have been enrolled within the SSI Program however didn’t obtain Money Funds.[9]

Events’ Arguments on Enchantment

In July 2017, the plaintiff hospitals sued HHS claiming that its components for figuring out the Medicare Fraction, and thus, reimbursement changes, was incorrect and sought correct reimbursement for fiscal years 2006‑2009, amongst different treatments.[10] They claimed that the Medicare Fraction ought to embrace all sufferers enrolled within the SSI Program on the time of hospitalization, no matter a affected person’s qualification for a Money Cost.[11] In addition they argued that people who certified for ancillary advantages below the SSI Program whereas being handled by a hospital, however not for Money Funds, must be counted as a result of they certified for advantages resulting from their enrollment within the SSI Program.[12] Beneath this formulation, extra people can be counted within the Medicare Fraction and thus hospitals would obtain larger reimbursement for such sufferers.[13]

HHS argued that the statutory language solely contains these people receiving Money Funds on the time of hospitalization,[14] and some other advantages obtained by sufferers are irrelevant for the needs of figuring out whether or not a hospital ought to obtain larger reimbursement for such sufferers.[15]

Appellate Courtroom’s Holding and Remaining Query for SCOTUS

In ruling for HHS, the D.C. Circuit Courtroom of Appeals affirmed the courtroom beneath, which discovered that HHS’s interpretation of the Medicare Fraction calculation was in step with the statutory language, which directs the calculation of the Medicare Fraction to incorporate solely people receiving the month-to-month Money Cost from the SSI Program.[16] Even when SSI Program enrollees grew to become eligible for ancillary advantages due to their enrollment within the SSI Program, these advantages didn’t qualify them to be counted within the Medicare Fraction.[17]

The Supreme Courtroom granted certiorari on the query of whether or not “entitled to SSI advantages” contains all these people enrolled within the SSI Program and never solely these qualifying for SSI Program Money Funds.[18] The Solicitor Basic’s workplace submitted a quick in assist of the decrease courtroom’s resolution, writing that it was in step with the longstanding interpretation of the statute and with selections of different courts.[19]

The Supreme Courtroom’s resolution is more likely to have a major affect on hospitals’ capability to hunt larger Medicare reimbursement for low-income sufferers, notably for hospitals in rural areas treating susceptible affected person populations.

Please contact a member of the Sheppard Mullin Healthcare Group in case you have questions.

FOOTNOTES

[1] 80 F.4th 346 (D.C. Cir. 2023); Supreme Courtroom of the US, Order Checklist: 602 U.S. (June 10, 2024), https://www.supremecourt.gov/orders/courtorders/061024zor_d18f.pdf.

[2] “Supreme Courtroom to determine Medicare reimbursement concern” by Michael Macagnone, Roll Name (June 10, 2024) (https://rollcall.com/2024/06/10/supreme-court-to-decide-medicare-reimbursement-issue/).

[3] 80 F.4th 346, 349.

[4] 80 F.4th 346, 349.

[5] Advocate Christ Medical Middle v. Becerra, 80 F.4th 346, 349, citing Cape Cod Hosp. v. Sebelius, 630 F.3d 203, 205 (D.C. Cir. 2011).

[6] 80 F.4th 346 at 349‑50.

[7] Id. at 350, citing 42 U.S.C. § 1382(a).

[8] Id.

[9] Id.

[10] Id. at 351.

[11] Id.

[12] Id. at 352. People who’re enrolled within the SSI Program additionally turn out to be eligible to use for Medicare Half D prescription-drug advantages, and a few may additionally apply for vocational rehabilitation companies. Id.at 349. People who stay enrolled within the SSI Program, however don’t obtain Money Funds, are nonetheless capable of entry these different advantages due to their standing as SSI Program enrollees. Id.

[13] Id. at 350.

[14] Id. at 350.

[15] Id. at 352.

[16] Id. at 353.

[17] Id. at 352.

[18] “Excessive Courtroom Agrees to Revisit 2022 Medicare Cost Ruling” by Tony Pugh, Bloomberg Regulation (June 10, 2024) (https://www.bloomberglaw.com/bloomberglawnews/health-law-and-business/XFFMM4R8000000?bna_news_filter=health-law-and-business#jcite).

[19] Transient for the Respondent, p. 11 Christ Medical Middle v. Becerra, No. 23-715 (2024).

*Regulation clerk not but admitted to follow.

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