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Relating to Consideration of S. 1932, Deficit Reduction Act of 2005

Location: Washington, DC

RELATING TO CONSIDERATION OF S. 1932, DEFICIT REDUCTION ACT OF 2005 -- (House of Representatives - February 01, 2006)



Mr. COOPER. Mr. Speaker, I would like to discuss a provision of S. 1932 that has caused great concern among hospitals throughout the State of Tennessee and in my own district. This provision relates to the calculation of Medicare disproportionate share payments for hospitals, commonly known as the DSH adjustment.

Congress created the DSH adjustment to provide appropriate funding to hospitals and other Medicare providers who care for a disproportionate share of low income inpatients. However, since its enactment into law, there has been a dispute between hospitals throughout the country and the Centers for Medicare and Medicaid Services (CMS) over how to calculate the DSH adjustment. Fifteen hospitals in Tennessee took CMS to court over this dispute in the case of Cookeville Regional Medical Center v. Thompson. At issue in Cookeville was whether CMS should include all Medicaid days related to a patient's stay in the DSH calculation, even if the patient was only eligible for Medicaid benefits through a federally approved Medicaid 1115 waiver program. CMS took the position it would exclude Medicare waiver days from the DSH calculation prior to January 20, 2000, in its discussion of an interim final rule promulgated on January 20, 2000.

On September 30, 2005, the United States District Court for the District of Columbia agreed with the Tennessee hospitals that Medicare waiver days must be included for the years 1994 to 2000. The Court determined that Congress intended to include these days in the DSH calculation when it enacted the Medicare DSH statute. CMS's interim final rule did not change that. For the Tennessee hospitals, the decision in Cookeville means up to $100 million in corrected payments covering the years 1994 to 1999. CMS appealed the District Court's September 30th decision on December 23rd.

Mr. Speaker, I thought that this resolved the matter, however I was disturbed to see language in S. 1932 that CMS might argue applies to the Cookeville case on appeal. Section 5002(b) of the Medicare Title of S. 1932 ratifies the interim final rule promulgated on January 20, 2000 by CMS and makes it effective on the date it was promulgated. In other words, CMS might attempt to accomplish legislatively what it could not accomplish in Cookeville.

I rise today to state, as a member of the House Budget Committee which has jurisdiction over S. 1932, the Deficit Reduction Act, that Sec 5002(b) should not be used to reverse the Cookeville decision and deny Tennessee its correct DSH payments as determined under the Medicare statute for the years 1994 through 1999.


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