QRS

Supreme Court Rules In Favor Of Hospitals In Allina II

By now, you may have already heard of the decision issued by the Supreme Court in Allina on June 3, 2019.  This decision will affect Medicare payments for your hospital. In that decision, the Court found in favor of hospitals with a strong majority.  In a 7-1 decision the Supreme Court held that the Medicare Statute requires proper rulemaking when changing a “substantive legal standard”. CMS was required to engage in notice and comment rulemaking before publishing the 2012 SSI ratios for hospitals.  The Supreme Court’s decision reverses the CMS’ rule to count Part C days in the Medicare Fraction (SSI) for discharges occurring before to October 1, 2013.


The decision makes it clear that CMS’ reliance on its authority to make substantive changes to Medicare without notice-and-comment rulemaking is not acceptable. The decision will require HHS to undergo rulemaking when it attempts to make a substantive change to Medicare payment amounts.


The government could apply the Supreme Court’s decision to: (1) the Allina plaintiffs only; (2) cases pending in court; (3) cases pending in court or at the PRRB; (4) all cases pending in court or at the PRRB or for which the time to appeal to the PRRB has not yet expired; or all affected cost years, open or closed.  We believe CMS will most likely apply the decision to all cases pending in court or before the PRRB or for which the time to appeal has not yet expired. Hospitals must file a timely appeal to the PRRB to participate in any settlement. QRS has begun the process of discussion and negotiations with CMS on behalf of our clients.


Please feel free to contact me directly to discuss this decision and how it may affect your hospital.


Brian Peterson
Senior Associate
QUALITY REIMBURSEMENT SERVICES, INC.
Healthcare Consultants
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EMAIL: BPeterson@qualityreimbursement.com
Internet Address: http://www.qualityreimbursement.com


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