What is a disproportionate share adjustment?

A payment adjustment under Medicare’s PPS for Medicaid utilization at hospitals that serve a relatively large volume of low-income patients, pregnant patients or other patients under the Medicaid program.

How do you calculate DSH percentage?

Because Hospital A is located in an urban area, has less than 100 beds, and has a DSH patient percentage of more than 20.2%, the formula for determining the Medicare DSH adjustment is: 5.88% + [. 825 x (DSH % – 20.2%)]. Urban hospitals with less than 100 beds are subject to a maximum DSH adjustment of 12%.

What was the reasoning behind reducing DSH payments?

One of the goals of the ACA was to extend insurance coverage, through Medicaid and the marketplaces, to millions of uninsured Americans. In doing so, policymakers believed that increased coverage would result in reduced uncompensated care and, thus, a reduced need for federal DSH payments.

How is operating DSH calculated?

Medicare DSH Payment: Counting Hospital Beds & Patient Days Determine the number of beds in a hospital, according to 42 CFR Section 412.105(b), by dividing the number of available bed days during the cost reporting period by the number of days in the cost reporting period.

What is Medicare DSH?

Medicare Disproportionate Share Payments (better known as DSH) are a critical component of overall Medicare inpatient payments and help offset the costs of care hospitals incur treating indigent patients.

What is DSH revenue?

Medicaid disproportionate share hospital (DSH) payments are statutorily required payments intended to offset hospitals’ uncompensated care costs to improve access for Medicaid and uninsured patients as well as the financial stability of safety-net hospitals.

Why is uncompensated care problematic?

Uncompensated care costs occur because, although people who are uninsured use less care than people with coverage, most who are uninsured have limited income or resources and cannot afford the high cost of medical care, if and when they do need or use health care.

What is a disproportionate share hospital?

Federal law requires that state Medicaid programs make Disproportionate Share Hospital (DSH) payments to qualifying hospitals that serve a large number of Medicaid and uninsured individuals. Medicaid Disproportionate Share Hospital (DSH) Payments | Medicaid Skip to main content

What is a DSH payment from Medicaid?

Provider Payment. Medicaid disproportionate share hospital (DSH) payments are statutorily required payments intended to offset hospitals’ uncompensated care costs to improve access for Medicaid and uninsured patients as well as the financial stability of safety-net hospitals.

Are hospitals serving a disproportionate share of low-income patients?

In response, legislation enacted in 1981 required states to “take into account” the situation of hospitals serving a disproportionate share of low-income patients when designing payment systems (§1902 (a) (13) (A) (iv) of the Social Security Act (the Act)).

What is the proposed rulemaking for Medicaid disproportionate share hospital allotments?

On July 27, 2017, CMS issued a notice of proposed rulemaking (NPRM) regarding Medicaid Disproportionate Share Hospital allotment reductions. This NPRM proposes a methodology to implement the annual reductions to state Medicaid DSH allotments for FY 2018 through FY 2025 as required by the Affordable Care Act.