Medicare Hospital IPPS FFY 2022 Final Rule: Empirical DSH - Section 1115 Waiver Days

The FFY 2022 Proposed Rule states Section 1115 days may be counted in the numerator of the Medicaid fraction only if the patient is eligible for inpatient hospital services under an approved State Medicaid plan that includes coverage for inpatient hospital care on that day or directly receives inpatient hospital insurance coverage on that day under a Section 1115 waiver. This excludes patient days for which hospitals receive payment from an uncompensated care pool.

CMS will continue to review the large number of comments on the proposed revision to the regulation relating to the treatment of section 1115 waiver days for purposes of the DSH adjustment. Due to the number and nature of the comments that CMS received in the FFY 2022 IPPS/LTCH PPS Proposed Rule, they intend to address the public comments in a separate document. 

Toyon’s Take

This has not been finalized and Toyon will continue to monitor any updates issued by CMS.

Please contact Dylan Chinea at Dylan.Chinea@toyonassociates.com with empirical DSH questions.