FFY 2023 IPPS Final Rule: Empirical DSH

Due to the volume and content of comments received, CMS is not finalizing its proposed treatment of section 1115 demonstration days. In the FFY 2023 IPPS Proposed Rule, CMS suggested:

• The interpretation of “regarded as eligible” pertained to: Patients who receive health insurance through a section 1115 demonstration itself or purchase such health insurance with premium assistance authorized by a section 1115 demonstration, where state expenditures may be matched with Title XIX funds.

• Allowable section 1115 days represent claims with insurance coverage with Essential Health Benefits (EHB), if bought with premium assistance, for which the premium assistance is equal to or greater than 90 percent of the cost of the coverage (Patient cannot be entitled to Medicare Part A coverage).

• Section 1115 days from a State uncompensated care payment are not allowable and excluded from the Medicaid fraction.

For more information, please contact Dylan Chinea at (925) 685-9312 or dylan.chinea@toyonassociates.com.