CMS proposes to retroactively include MA days in Medicare DSH calculation

Aug 04, 2020 - 05:24 PM
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The Centers for Medicare & Medicaid Services Aug. 4 released a proposed rule that would retroactively incorporate Medicare Advantage days into the Medicare fraction of a hospital’s disproportionate patient percentage for the Medicare Disproportionate Share Hospital program.

CMS has included MA days in the Medicare fraction since finalizing the policy in the fiscal year 2014 inpatient prospective payment system final rule.

In today’s rule, CMS proposes to retroactively include MA days in the Medicare fraction for discharges before Oct. 1, 2013, the effective date of the FY 2014 inpatient PPS final rule. It previously vacated the policy for the time period before Oct 1, 2013 in light of legal challenges, including a ruling by the Supreme Court.

“The effect of this proposed rule would be to avoid the consequences of legal ambiguity that would otherwise continue into the future,” CMS said. Comments are due 60 days after the rule’s Aug. 6 publication in the Federal Register.

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