The regulation adjusts those civil monetary penalties to account for annual inflation, increasing civil monetary penalties using consumer price index and cost-of-living data for year 2019. This final rule became effective on November 5, 2019.
The Centers for Medicare & Medicaid Services (CMS) also published 84 FR 59529, finalizing payment methodologies associated with Basic Health Plans (BHP) under the Affordable Care Act for years 2019 and 2020. Currently, states pay a portion of BHP costs each year. However, the proposed change in BHP methodology will shift an additional portion of BHP costs from the federal government to the states, with a potential increase in beneficiary contributions and potential decreases in provider payment rates (including rates to standard health plans in the BHP). This final rule becomes effective January 6, 2020.
Missouri Hospital Assoc. v. Azar, No. 18-1778 (8th Cir. 2019): In this matter, the Eighth Circuit held that an HHS rule requiring Medicaid reimbursements for Disproportionate Share Hospitals (DSH) (i.e., hospitals that serve a number of low-income patients) to be reduced based on payments they receive from Medicare and private insurers is valid. At the district court below, the Missouri Hospital Association (MHA) challenged the rule’s definition of “costs incurred” and the discretion it delegated to the Secretary of HHS to include payments by Medicare and private insurance in the DSH payment calculation. The Eighth Circuit reversed the district court’s grant of summary judgment for MHA.
The Eighth Circuit’s reversal follows a U.S. Court of Appeals for the District of Columbia Circuit decision we previously covered in August of this year, Children’s Hospital Association of Texas, et al. v. Azar. In that decision, the D.C. Circuit held that Congress “did not intend to exclude Medicare and private insurance payments” from the methodology used to reduce payments for hospitals serving low-income patient populations.