HHS asks Supreme Court to review Medicare payments ruling: 7 things to know

HHS is calling on the U.S. Supreme Court to review a District of Columbia appeals court ruling that Medicare was inappropriate when it altered its methods for calculating uncompensated care reimbursements six years ago, according to Law360.

Here are seven things to know.

1. The United States Court of Appeals for the District of Columbia Circuit issued the ruling in July 2017.

2. HHS filed a petition asking the U.S. Supreme Court to review the appeals court decision. HHS states that the July ruling conflicted with other appeals courts decisions. According to Law360, those decisions found CMS' changes to Medicare reimbursements do not have to conduct notice-and-comment rulemaking. The petition states: "The decisions of other courts of appeals reflect the view that instructions from HHS to its Medicare Administrative Contractors, [which act on behalf of the agency] about Medicare fractions lack the force and effect of law, and thus do not qualify as a 'substantive legal standard'" with regards to Medicare reimbursement."

3. The petition to the U.S. Supreme Court comes roughly four months after the D.C. Circuit Court declined to reconsider its previous ruling, according to Law360.

4. HHS stated in its petition: "The court of appeals' decision threatens to undermine HHS' ability to administer the Medicare program in a workable manner."

5. In 2014, a group of hospitals filed a lawsuit over CMS' move to include Part C enrollees with Part A enrollees when calculating disproportionate share hospital payments, which reimburse hospitals for care delivered to indigent patients. The move resulted in lower payments to hospitals, according to Law360. The lawsuit sought to push CMS to recalculate the DSH formula without Plan C enrollees.

6. HHS is calling on the U.S. Supreme Court to take another look at the appeals court decision because the agency contends it "creates a circuit split by holding that Section 1395hh's notice-and-comment procedures apply to interpretive rules." The agency argues the D.C. court's decision undermines the agency's ability to conduct its reimbursement program.

7. CMS no longer groups patients with Part C Medicare plans with Part A enrollees for those reimbursement purposes, according to the report.

Access Law360's full report here. Read the full petition here.


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