953 F. Supp. 2d 180
D.D.C.2013Background
- KU, Via Christi, and Stormont-Vail challenge the Secretary's 1996 Medicare DSH adjustment decision.
- The dispute centers on MediKan (State-only) days being included in Medicaid Fractions for the DSH calculation.
- HCFA Ruling 97-2 and the Program Memorandum guide how Medicaid and State-only days are treated.
- The Program Memorandum provides a hold harmless provision to protect providers relying on erroneous prior payments, limited to days actually paid in the past.
- The Secretary concluded secondary MediKan days were not paid in the past and thus not eligible for hold harmless relief; primary MediKan days were previously paid and thus eligible.
- The court grants summary judgment for the Secretary, denying the hold harmless relief for MediKan days and affirming exclusion of MediKan days from the Medicaid Fraction.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Are MediKan days Medicaid-eligible under the DSH statute? | MediKan days should be included under hold harmless protection. | MediKan days are not Medicaid-eligible for DSH purposes. | MediKan days are not Medicaid-eligible; must be excluded. |
| Does the Past Payment Prong obligate inclusion of secondary MediKan days? | Past payments require including secondary MediKan days. | Past Payment applies only to days previously included in past cost reports. | Past Payment Prong does not require inclusion of secondary MediKan days. |
| Should the Secretary distinguish between primary and secondary MediKan days? | Distinction is irrelevant; all MediKan days fall under hold harmless. | Distinct treatment is consistent with the hold harmless provision. | Yes, distinction is proper; only days previously paid are eligible for hold harmless. |
Key Cases Cited
- Adena Regional Medical Center v. Leavitt, 527 F.3d 176 (D.C. Cir. 2008) (medical-assistance meaning includes Medicaid funds; state-only days not eligible)
- Cabell Hunting Hosp., Inc. v. Shalala, 101 F.3d 984 (4th Cir. 1996) (Medicaid-eligible days include those not reimbursed, per statutory interpretation)
- Jewish Hosp., Inc. v. Sec’y of Health & Human Servs., 19 F.3d 270 (6th Cir. 1994) (Medicaid fraction includes Medicaid-eligible days irrespective of payment status)
- Phoenix Memorial Hospital v. Sebelius, 622 F.3d 1219 (9th Cir. 2010) (interpretation of medical assistance and state-plan eligibility in DSH context)
- Rush Univ. Med. Ctr. v. Leavitt, 535 F.3d 735 (7th Cir. 2008) (hold-harmless provisions and past-practice considerations in Medicare corrections)
- Univ. of Wash. Med. Ctr. v. Sebelius, 634 F.3d 1029 (9th Cir. 2011) (limits of 'eligible for medical assistance' in DSH calculations)