Feds Define ‘Uninsured’ In The Context Of The Medicaid DSH Payment

On December 31, 2014, the federal Centers for Medicare and Medicaid Services (CMS) implemented a new definition for “uninsured” to be used in the context of calculating Medicaid disproportionate share hospital (DSH) payments. The rule is based on whether a patient has third-party coverage for specific hospital inpatient and outpatient services. It allows hospitals to include costs of various categories of patients previously excluded from calculating the Medicaid shortfalls and uninsured costs. Going forward, the DSH calculation of uncompensated care costs  (UCC) will be based on the following components:

Medicaid shortfalls, defined as  the net of the costs incurred . . .