Myers and Stauffer can assist states in issuing an addendum for the DSH examination years 2011 through 2015, if modification was not already requested.
For clients that request this modification, the modified DSH examination report format would include one DSH limit calculation for each hospital that would exclude all Medicare and private insurance payments based on CMS bulletin issued December 31, 2018. For some clients, additional data collection may be required for cost report periods overlapping earlier DSH years – particularly DSH years 2011 and 2012. For many states, Myers and Stauffer already has collected the necessary data to recalculate uncompensated costs of care excluding Medicare and private insurance payments for DSH years 2013 and beyond.
For any upcoming DSH examination reports (state plan rate years 2017 and after) that include hospital services provided on or after June 2, 2017, a data caveat and applicable footnotes will be included in the report to disclose the uncertainty created by the pending appeal on the Children’s Hospital Association of Texas case. The DSH auditors are issuing a report with an opinion on a state’s compliance with the final DSH audit rule and CMS guidance; however, there are court rulings that may affect the current CMS guidance. The caveat will include a brief reference to the court rulings and any state Medicaid agency input requested.
We also understand that every state is unique and has legal counsel advice and other issues to consider. We will work with each state to understand their specific circumstances and propose any needed changes to the DSH examination report.
In view of the foregoing, state agencies should consult with their legal counsel and consider potential risks before making final decisions. State agencies may also want to consult with their regional CMS officials.