Congress released a stopgap funding bill with a significant healthcare package, and provider groups are reacting favorably. They are mainly applauding provisions that reign in PBMs’ business practices, extend telehealth flexibilities, and boost payments to hospitals and physicians.
Forty-two safety net hospitals recently sued HHS, alleging that the Medicare program “unlawfully withheld and unreasonably denied” DSH payments for decades. The plaintiff hospitals said that HHS' failure to recalculate DSH payments have cost them "tens of millions of dollars in funds that should have been paid to them many years ago."
The home care industry is booming. As Baby Boomers age and more families seek in-home solutions for loved ones, demand for home care services is at an all-time high.
The hospitals are pushing HHS to recognize patients eligible for Medicaid under the ACA as "low-income" when calculating Medicare disproportionate share hospital payments in states that did not expand Medicaid. The agency's refusal to do so resulted in the hospitals receiving lower reimbursements for three years, the lawsuit claims.