On June 10, 2024, the U.S. Supreme Court docket granted certiorari in Advocate Christ Medical Heart v. Becerra[1] for the October 2024 – 2025 time period to overview a D.C. Circuit Court docket of Appeals ruling probably affecting as much as $4 billion in federal funding for hospitals.[2] The Supreme Court docket will decide whether or not the federal Division of Well being and Human Providers (“HHS”) correctly reimbursed hospitals for offering care to sufferers receiving monetary help from the Supplemental Safety Revenue Program (the “SSI Program”).[3] Hospitals benefiting from Medicare reimbursement changes for treating low-income sufferers ought to carefully monitor this case, as a good ruling for the plaintiffs might influence how hospitals are reimbursed for comparable claims sooner or later.
Background
Advocate Christ Medical Heart facilities on how a lot hospitals could be reimbursed for treating low-income Medicare beneficairies.[4] HHS makes fastened funds for companies supplied by hospitals to Medicare Half A beneficiaries and adjusts these funds for hospitals that serve an “unusually excessive proportion of low-income sufferers” as a result of these sufferers usually require extra care.[5] This proportion is expressed in a fraction (the “Medicare Fraction”) utilizing information from the Social Safety Administration (“SSA”) as to which Medicare sufferers are “entitled to SSI advantages.”[6]
The first SSI Program profit at problem consists of month-to-month money funds made to needy people who’re aged, blind, or disabled (“Money Funds”).[7] People who’re enrolled within the SSI Program should show eligibility every month to obtain Money Funds, however stay enrolled within the SSI Program even when they don’t qualify for Money Funds in a specific month.[8] Every month, for the aim of figuring out the Medicare Fraction, HHS counts solely these people who have been entitled to obtain Money Funds underneath the SSI Program and doesn’t depend people who have been enrolled within the SSI Program however didn’t obtain Money Funds.[9]
Events’ Arguments on Enchantment
In July 2017, the plaintiff hospitals sued HHS claiming that its method for figuring out the Medicare Fraction, and thus, reimbursement changes, was incorrect and sought correct reimbursement for fiscal years 2006‑2009, amongst different treatments.[10] They claimed that the Medicare Fraction ought to embrace all sufferers enrolled within the SSI Program on the time of hospitalization, no matter a affected person’s qualification for a Money Fee.[11] Additionally they argued that people who certified for ancillary advantages underneath the SSI Program whereas being handled by a hospital, however not for Money Funds, ought to be counted as a result of they certified for advantages on account of their enrollment within the SSI Program.[12] Beneath this formulation, extra people could be counted within the Medicare Fraction and thus hospitals would obtain increased reimbursement for such sufferers.[13]
HHS argued that the statutory language solely consists of these people receiving Money Funds on the time of hospitalization,[14] and every other advantages obtained by sufferers are irrelevant for the needs of figuring out whether or not a hospital ought to obtain increased reimbursement for such sufferers.[15]
Appellate Court docket’s Holding and Remaining Query for SCOTUS
In ruling for HHS, the D.C. Circuit Court docket of Appeals affirmed the court docket beneath, which discovered that HHS’s interpretation of the Medicare Fraction calculation was in line with the statutory language, which directs the calculation of the Medicare Fraction to incorporate solely people receiving the month-to-month Money Fee from the SSI Program.[16] Even when SSI Program enrollees grew to become eligible for ancillary advantages due to their enrollment within the SSI Program, these advantages didn’t qualify them to be counted within the Medicare Fraction.[17]
The Supreme Court docket granted certiorari on the query of whether or not “entitled to SSI advantages” consists of all these people enrolled within the SSI Program and never solely these qualifying for SSI Program Money Funds.[18] The Solicitor Common’s workplace submitted a short in help of the decrease court docket’s determination, writing that it was in line with the longstanding interpretation of the statute and with choices of different courts.[19]
The Supreme Court docket’s determination is prone to have a major influence on hospitals’ means to hunt increased Medicare reimbursement for low-income sufferers, significantly for hospitals in rural areas treating weak affected person populations.
Please contact a member of the Sheppard Mullin Healthcare Crew when you have questions.
FOOTNOTES
[1] 80 F.4th 346 (D.C. Cir. 2023); Supreme Court docket of america, Order Record: 602 U.S. (June 10, 2024), https://www.supremecourt.gov/orders/courtorders/061024zor_d18f.pdf.
[2] “Supreme Court docket to determine Medicare reimbursement problem” by Michael Macagnone, Roll Name (June 10, 2024) (https://rollcall.com/2024/06/10/supreme-court-to-decide-medicare-reimbursement-issue/).
[3] 80 F.4th 346, 349.
[4] 80 F.4th 346, 349.
[5] Advocate Christ Medical Heart v. Becerra, 80 F.4th 346, 349, citing Cape Cod Hosp. v. Sebelius, 630 F.3d 203, 205 (D.C. Cir. 2011).
[6] 80 F.4th 346 at 349‑50.
[7] Id. at 350, citing 42 U.S.C. § 1382(a).
[8] Id.
[9] Id.
[10] Id. at 351.
[11] Id.
[12] Id. at 352. People who’re enrolled within the SSI Program additionally change into eligible to use for Medicare Half D prescription-drug advantages, and a few may additionally apply for vocational rehabilitation companies. Id.at 349. People who stay enrolled within the SSI Program, however don’t obtain Money Funds, are nonetheless in a position to entry these different advantages due to their standing as SSI Program enrollees. Id.
[13] Id. at 350.
[14] Id. at 350.
[15] Id. at 352.
[16] Id. at 353.
[17] Id. at 352.
[18] “Excessive Court docket Agrees to Revisit 2022 Medicare Fee Ruling” by Tony Pugh, Bloomberg Legislation (June 10, 2024) (https://www.bloomberglaw.com/bloomberglawnews/health-law-and-business/XFFMM4R8000000?bna_news_filter=health-law-and-business#jcite).
[19] Temporary for the Respondent, p. 11 Christ Medical Heart v. Becerra, No. 23-715 (2024).
*Legislation clerk not but admitted to follow.
