HHS Response Modifying Provider Reimbursement Review Board Regarding Decision On Maine Type 6 Medicaid Dual Eligible Days DSH Groups

June 4, 2013
Eight Maine hospitals are challenging the federal Medicare program over how Medicare disproportionate share hospital (DSH) payments should be calculated for hospitals that serve a large percentage of low-income patients. The issue is how the hospitals’ methodology accounted for inpatient stays by dual eligibles (people enrolled in both Medicare and Medicaid). The Medicare DSH payment is linked to the number of Medicaid beneficiaries a hospital serves. In 1997 the hospitals were told to count dual eligibles; in 2003 they were told that duals should not be counted. The federal government sought repayment of the difference between . . .