CMS Issues FAQs on DSH Auditing and Reporting Rule - January 26, 2010

CMS has issued Frequently Asked Questions related to the DSH Auditing and Reporting final rule published on December 19, 2008. The FAQ document reiterates many of the conclusions from the final rule, including that the hospital-specific DSH limit:

1. Does not include any costs related to any individual with creditable coverage, regardless of whether that coverage provides adequate coverage for a particular service received.
2. Limits hospital services to inpatient and outpatient hospital services as defined in the Medicaid state plan.
3. Includes the costs and payments associated with patients covered both by Medicaid and another payer (e.g. dual-eligibles and people with both private and Medicaid coverage). Payments from non-Medicaid sources will offset Medicaid payment shortfalls when determining DSH limits.

The document further reiterates that CMS will permit states to submit audit reports for State plan rate years 2005 and 2006 by December 31, 2010, despite the December 31, 2009 deadline in the final rule. Please contact Sarah Mutinsky at NAPH’s legal counsel of Ropes and Gray, LLP with questions.