Dive Brief:
- Several hospitals in Norh Carolina are suing the federal government over reimbursement changes under the Affordable Care Act (ACA).
- The lawsuit is related to cuts to "disproportionate share" payments, which were initially designed to help hospitals that serve a large portion of uninsured patients.
- The payments were cut under the ACA because the number of uninsured patients was expected to drop as states expanded Medicaid, which North Carolina declined to do.
Dive Insight:
According to Cone Health, which is participating in the lawsuit, CMS owes the system an additional $2.2 million for last year under the revised disproportaional share formula. "Because of the vague and general drafting of legislation, and the ACA in particular, CMS is given discretion over a lot of technical calculations that can have a large impact on provider payments," Cone Health said in a related statement. "As we understand it, CMS’s goal is to interpret these calculations in a way that minimizes Medicare outlays. This means that healthcare systems, as a routine matter, challenge these interpretations to ensure transparency, rigor, and a collective provider voice in these determinations. And the vehicle to do this is typically group appeals such as this."