Dive Brief:
- Nine New Jersey hospitals have joined forces in a lawsuit against HHS Secretary Sylvia Mathews over allegations the agency incorrectly reduced their Medicare payments.
- The issue is around the hospitals' treatment of low-income patients through the New Jersey Charity Care Program (NJCCP).
- The hospitals argue in 2006 and 2007 HHS incorrectly excluded NJCCP patients when calculating disproportionate shared hospital payments because the patients were ineligible for Medicaid.
Dive Insight:
The legal question involves Section 1115 of the Social Security Act, which gives the HHS secretary the authority to approve projects that promote Medicaid objectives of the Medicaid program, and allows states to expand eligibility to patients not otherwise eligible for Medicaid or the Children's Health Insurance Program, according to Becker's Hospital Review.
The hospitals say HHS inconsistently applied the statute by allowing Section 1115 waiver program patients to be counted in the DSH calculation while also electing not to recognize NJCCP days in the calculation.
The lawsuit requests the matter be remanded to the Provider Reimbursement Review Board for recalculation and amended payment be made to the impacted hospitals, Becker's reports.