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Wednesday, October 5, 2022

Supreme Court Hears Dispute Over Medicare Payment Formula for Safety Net Hospitals

The Supreme Court appeared to coldly greeted the Biden administration this morning during an oral debate in a case in which the health care system was demanding higher government reimbursements for treating low-income patients.

The case of Becerra v. Empire Health Foundation is in case 20-1312. Xavier Becerra is the United States Secretary of Health and Human Services.

The question in this case is how the US Department of Health and Human Services (HHS) calculates Medicare special payments for “disproportionate hospitals,” sometimes called “DSH hospitals,” whose patients are primarily low-income individuals.

There was also the so-called Chevron doctrine, according to which courts rely on departmental interpretation of the laws they apply. In Chevron v. Natural Resources Defense Council, the Supreme Court ruled in 1984 that the executive’s interpretation of the statute it governs is entitled to respect, unless Congress specified otherwise.

The elderly and people with disabilities receive health insurance in accordance with the Health Care Act. According to the statute, hospitals generally charge a fixed fee for services rendered. Hospitals are paid predetermined dollar amounts for each Medicare patient treated, but the fees paid to DSH hospitals are being increased to cover the higher costs of treating people on low incomes who often have deteriorating health.

HHS increases payments to DSH hospitals using a mathematical formula. The department is adding two factions, known as the Medicare Faction and the Medicaid Faction, each of which separately measures low-income patients in the hospital. Medicaid is a joint federal-state program to help the poor. Sometimes people are eligible to participate in both programs at the same time, and they are called “dual entitlements”.

“The Medicare faction evaluates the low-income Medicare hospital patients by determining the percentage of Medicare patients who also received Supplemental Income Income or SSI benefits,” said SCOTUSblog in a preview of the case. “The Medicaid Faction estimates the percentage of patients in a low-income Medicaid hospital by measuring the percentage of hospital patients who were Medicaid eligible but not Medicare eligible. … Medicare beneficiaries are excluded from the numerator of Medicaid shares to avoid double counting patients who receive both Medicare and Medicaid coverage. ”

How to interpret the phrases “eligible” and “eligible” in fractions is controversial.

“The phrase“ eligible ”is used when referring to Medicare patients, while the phrase“ eligible ”is used when referring to Medicaid patients,” writes SCOTUSblog. “These phrases have a long and hectic history, and these stories help to confuse attempts to define their current meaning.”

During the oral debate on November 29, judges at times complained furiously about the incomprehensibility of the wording of the charter.

Judge Clarence Thomas told Justice Department attorney Jonathan S. Bond that the law was bogged down in “illegible language.”

Judge Sonia Sotomayor told Bond that the law was muddled. “Can you point to any other law in which Congress applies three meanings to the same word?” she asked.

She also asked how “do we give you any respect for Chevron” for the government’s preference for the interpretation of the law?

During the discussion of patients depleting their benefits, Judge Stephen Breuer played with words with Bond, saying that such people are “as tired as I am after reading this case, okay?”

“If I were in Congress and this question was in front of me, you know what I would say? Let the agency do what it wants as long as it’s reasonable, because I have no idea, ”Breuer said.

“So my question is, how are we expected, nine people when there were only two people in the United States in 2003? [public comment period] figured it out in the form of comments, how are we supposed to decide who is right? “

This is a developing story. This article will be updated.

To follow

Matthew Wadum is an award-winning investigative journalist and recognized expert on the leftist movement.

World Nation News Desk
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