SCOTUS sides with HHS in hospital payment case
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The Supreme Court sided with Health and Human Services on Tuesday in a case over whether safety net hospitals that care for low-income seniors should get higher Medicare reimbursements.
Why it matters: Billions of dollars were on the line for the more than 200 hospitals pressing the case, who claimed they'd been underpaid from 2006 to 2009.
Driving the news: Justices ruled 7-2 that Medicare used the appropriate method for calculating the safety-net payments, with Justice Elena Kagan joining the court's conservatives.
- The dispute centered on so-called disproportionate share payments that hospitals get based in part on how many days they care for patients who are on both Medicare and Supplemental Security Income.
- HHS only reimburses hospitals for those patients who received cash benefits in the month of their hospitalization.
- Illinois-based Advocate Christ Medical Center led more than 200 hospitals in suing the federal government in 2017, arguing the facilities should get credit for taking care of people who don't obtain benefits in a particular month or who aren't eligible for cash benefits but can get other SSI-related services.
State of play: The majority of justices ruled that the law considers SSI to refer to cash benefits, with eligibility determined on a monthly basis.
- A patients' SSI eligibility status "is not a perfect measure of income — but neither is income a perfect measure of whether a patient is more costly to treat," Justice Amy Coney Barrett wrote for the majority.
- "In the end, the Medicare fraction and ultimate DSH adjustment reflect a balance of multiple competing interests, including increased funding for hospitals, administrability, efficiency, and allocation of finite resources."
The other side: Justice Ketanji Brown Jackson, joined by Justice Sonia Sotomayor, wrote in a dissent that the opinion endorses a formula that "arbitrarily undercounts" the low-income patients served by a hospital.
- "The decision the majority has made in this case will deprive hospitals serving the neediest among us of critical federal funds that Congress plainly attempted to provide," she added.
Zoom in: America's Essential Hospitals, a trade group for safety-net facilities, expressed disappointment, saying the payments in question "are key to the financial stability of essential hospitals and help to ensure access and high-quality care for all," said Beth Feldpush, senior vice president of policy and advocacy.
- Advocate Christ Medical Center and HHS did not respond to requests for comment.
