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Senators Back Hospitals On Payment Challenges

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Tampa General Hospital
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Tampa General Hospital is throwing its support behind a bipartisan proposal that, if passed by Congress, would allow it and other large health-care systems to challenge how the government estimates additional Medicare payments.

U.S. Sen. Marco Rubio, R-Fla., and U.S. Sen. Bill Nelson, D-Fla., are filing legislation Tuesday that would strike a provision in current law that precludes hospitals from challenging such payment decisions or the data used in reaching the decisions.

John Couris, president and CEO of Tampa General Hospital, said in a statement that the legislation would restore “transparency, fairness, and due process for Tampa General Hospital and all of Florida’s safety net hospitals, allowing us to challenge major errors made by the (federal) Centers for Medicare & Medicaid Services (CMS) when they occur.”

Tampa General was at risk of losing $2 million in what are known as Medicare “disproportionate share” payments last year after a Medicare claims administrator did not include updated Medicare uncompensated-care claims data in government forms. Rubio’s office intervened to prevent the cut to the 1,011-bed hospital, which serves as the primary teaching hospital for the University of South Florida’s medical school and cares for large numbers of low-income patients.

The legislation, though, would offer a more-permanent fix by eliminating a prohibition on administrative and legal challenges.

The original purpose of Medicare disproportionate share payments was to provide additional money to hospitals that treat large shares of low-income patients, who tend to be sicker and cost more.

The so-called DSH payment is calculated as a percentage add-on to the basic Medicare payments hospitals already receive. The amount of DSH money a hospital receives has traditionally been determined by a formula that includes the sum of two ratios: the proportion of all Medicare days that are attributable to beneficiaries of Supplemental Security Income and the proportion of all patient days for which Medicaid is the primary payer.  

The federal Affordable Care Act changed the DSH formula, though, and after fiscal year 2014, hospitals are receiving 25 percent of the amount they previously would have received. The federal law, better known as Obamacare, also made clear that hospitals aren’t entitled to administrative or judicial review of any estimate used to determine DSH payments.

Stephen Harris, Tampa General Hospital vice president of payor and government relations, told The News Service of Florida that “a good deal” of hospital information is used to derive the formulas.