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CMS proposes to change definition of uninsured for determining DSH payments
CMS (Baltimore, MD) proposed a change in the definition of uninsured for the purpose of determining disproportionate share hospital (DSH) payments based on whether the patients were covered for the specific services provided by a hospital. The current definition of uninsured patients says that a patient is insured if they have any active insurance coverage, regardless of whether their insurance covers the specific services provided.
This definition excludes from uncompensated care the costs of many services that were provided to individuals with insurance coverage but were outside the scope of coverage. The proposed change also would consider DSH payments for any service provided that is not covered by an insurance policy because it exceeds a policy's annual or lifetime limits. The National Association of Public Hospitals and Health Systems (Washington, DC) (NAPH) will submit comments to CMS during the 30-day comment period, on the three types of costs that are still excluded from DSH payments that it would like to see included. These include unpaid co-payments and deductibles; payments that have been administratively denied; and cost of care to prisoners. For the third category, the uncompensated care cost can be included in the DSH limit only for those inmates who have been released from secure custody. |
