HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Sunday, January 2, 2005

CMS: Uninsured Discounts Won't Alter Outlier Calculation

The Centers for Medicare and Medicaid Services (CMS) recently added a new hospital FAQ to address a concern raised by many hospitals.  The bottom line is that hospital discounts to uninsured patients, regardless of the patients' financial status, will not have an effect on either outlier payments or new technology payments, because the cost-to-charge ratio is applied, in both situations, to the undiscounted Medicare covered charges from each Medicare claim to calculate the additional payment, if any.  As we all know, one of the key claims in most, if not all, of the class actions filed against nonprofit hospitals around the country in the past six months touch on precisely this point.  According to the complaints, NFPs should charge all uninsured patients the same discounted charges they negotiate with managed care organizations or are obtained by Medicare and Medicaid.  (See, e.g., the "fact sheet" at the plaintiffs' litigation web site.)  This FAQ provides some assurance that such across-the-board discounts won't produce a double hit on the hospitals' bottom line.

All of CMS' FAQs concerning the uninsured (except this new one) are collected here[tm]

January 2, 2005 | Permalink | Comments (0)

Mental Health Legislation - 108th Congress

The Bazelon Center for Mental Health Law has an overview of the mental health legislative successes and failures in the 108th Congress.  Some of the better news includes  the enactment of grant programs for suicide prevention and criminal justice diversion, new mental health funding, and secured protections in renewal of the special education law.  On the downside, congress failed to act on furthering mental health parity legislation, laws to prevent custody relinquishment, and various bills to assist a failing public mental health system. 

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January 2, 2005 | Permalink | Comments (0)