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DSH Audit and Reporting Rule Comments and Requirements

The Medicaid Disproportionate Share Hospital (DSH) Reporting and Audit Rule, which has been in effect since 2008, requires states to report to CMS about DSH payments made to individual hospitals and limits the types of costs a hospital may claim to receive DSH payments. Under this rule, hospitals would not be paid for physician costs and pharmaceuticals for the uninsured and for uncompensated care for the underinsured. America’s Essential Hospitals supports transparency in the Medicaid program, but has requested that the Obama Administration revise the portions of the rule that would cut payments to hospitals for services provided to un- and under-insured patients.

Medicaid DSH Uninsured Definition

Association Comments on Proposed Rule

Submitted February 2012. The association submitted comments that expressed appreciation with CMS for acknowledging that the 2008 definition of the uninsured excludes costs of medically necessary services, which would significantly limit hospitals’ funding. The association urged CMS to finalize the proposal to change the definition of the uninsured to a service-specific definition, which includes the costs of their care in the DSH limit calculation.

Proposed Rule

Published January 2012.

DSH Reporting Rule

Association Urges HHS Secretary Sebelius to Reevaluate DSH Reporting Rule

The association sent a letter to the Secretary of the Department of Health and Human Services (HHS), Kathleen Sebelius, urging her to reevaluate damaging policy changes implemented through the Medicaid Disproportionate Share Hospital (DSH) Audit and Reporting Rule.

Association Summary of Final Rule

On December 19, 2008, the Centers for Medicare and Medicaid Services (CMS) published the long-anticipated Final Rule establishing new Medicaid disproportionate share hospital (DSH) reporting and audit requirements which were mandated by Section 1001(d) of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). The rule finalizes a proposal issued Aug. 26, 2005. This memorandum provides a summary of the final rule.

Association Comments on Proposed Rule
Submitted October 2005.

 

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