Supreme Court Revisits the Meaning of “Entitled” for Purposes of the Medicare Disproportionate Share Hospital Adjustment

• December 11, 2024

• Kenneth R. Marcus

To paraphrase from the poet Gertrude Stein, does “entitled mean entitled mean entitled”? While on November 5, 2024 all eyes were on the election results, the United States Supreme Court wrestled with that question during oral argument in the case of Advocate Christ Medical Center, et al. v. Xavier Becerra, Secretary of Health and Human Services, No. 23-715. In that case, the Court revisited the meaning of “entitled” as it appears twice in the Medicare Fraction of the statute for the disproportionate share hospital (DSH) adjustment. In its 2022 decision in Becerra v. Empire Health Found, the Court held that “entitled” to Medicare Part A benefits means eligible for such benefits without regard to whether a Medicare payment is made for a specific hospital stay. In Advocate Christ, the Court will determine the meaning of “entitled” for purposes of supplemental security income (SSI) benefits where, although enrolled in the SSI program, no SSI payment was made during the month of a patient’s hospital admission. While the uninitiated would believe that it would be a simple matter for the Supreme Court to simply follow the Empire Health decision, there is more to the issue than meets the eye.

ARTICLE TAGS

• Regulation, Accreditation, and Payment Practice Group
• Government Reimbursement