HR5064-119

What This Bill Does

The Save our Safety-Net Hospitals Act changes the Medicaid disproportionate share hospital limit that constrains payments to hospitals serving large numbers of Medicaid and uninsured patients. It adds payments under Medicare title XVIII and applicable plans to the calculation for certain Medicaid-eligible patients when the state plan or waiver remains a payor after other benefits and the hospital's costs still exceed total payments. It removes the special paragraph that limited certain hospitals, applies the revised rule to Medicaid state plan rate years beginning on or after enactment, and gives states a retroactive option for rate years beginning on or after October 1, 2021 and before enactment. If a state did not spend its full DSH allotment for those years, it may use the unspent amount to increase hospital payment adjustments, may retroactively modify Medicaid plans, waivers, or state plan amendments before the audit deadline, and may not recoup payments that were consistent with the October 1, 2021 rule.

Who Benefits and How

Safety-net hospitals benefit because more Medicaid DSH payment room can be available when their costs exceed Medicaid, Medicare, and applicable-plan payments. Hospitals serving dual-eligible patients benefit because the bill accounts for Medicaid-eligible patients after Medicare or other plan benefits apply. State Medicaid agencies benefit from authority to use unspent DSH allotments for prior rate years beginning after October 1, 2021. Low-income patients benefit indirectly if safety-net hospitals receive more stable uncompensated-care support.

Who Bears the Burden and How

CMS Medicaid staff must review retroactive state plan, waiver, or state plan amendment modifications. State Medicaid agencies must document increased payment adjustments and include them in annual DSH reporting. Federal taxpayers bear higher federal Medicaid spending if states use unspent DSH allotments for increased payments. Hospital auditors must account for revised DSH calculations and the independent certified audit deadline.

Key Provisions

• Modifies Medicaid DSH hospital-specific payment limits for certain Medicaid-eligible patients.
• Adds Medicare title XVIII and applicable-plan payments to the cost and payment calculation.
• Authorizes states to use unspent DSH allotments for certain prior rate years beginning on or after October 1, 2021.
• Blocks recoupment of qualifying payment adjustments consistent with the October 1, 2021 rule.
• Allows retroactive Medicaid plan or waiver modifications before the independent certified audit deadline.