The United States Supreme Court has granted certiorari to hear a hospital’s challenge to how the Department of Health and Human Services calculates disproportionate share (“DSH”) payments for hospitals serving low-income patients. The case, Advocate Christ Medical Center et al. v. Bercerra, involves the statutory interpretation of whether the phrase “entitled…to benefits” means the same thing for Supplemental Security Income (“SSI”) benefits as it does for Medicare Part A.
The statutory formula for paying hospitals that disproportionately serve low-income patients uses a “Medicare fraction” expressing the proportion of a hospital’s Medicare patients with low incomes, who are identified by their entitlement to SSI benefits. The federal District Court for the District of Columbia had ruled in favor of the Department’s inclusion of only those patients who received cash benefits in the determination of patients entitled to SSI benefits. Advocate had argued that this approach was inconsistent with the Supreme Court’s decision in Bercerra v Empire Health Foundation, which held that patients “entitled to” Medicare benefits should be used in the formula even if Medicare does not pay for their hospital stay. The Bercerra v. Empire Health decision left open the question of whether those “entitled to [SSI] benefits” also includes all those who qualify for the program regardless of whether they received cash payments while in the hospital.
The American Hospital Association and other hospital associations had filed amicus briefs supporting Advocate’s petition for certiorari. In a statement, AHA’s general counsel and secretary Chad Golder said:
The AHA is pleased that the Supreme Court agreed to consider this case. As we explained in our amicus brief urging the Court to grant certiorari, it is critical to hospitals and health systems that HHS interpret the DSH fraction consistently across the statute. The agency’s failure to do so has cost hospitals more than a billion dollars each year, directly harming the hospitals that serve America’s most vulnerable patients. We look forward to the Supreme Court rectifying this legal error next term.