Advocate Christ Medical Center v. Xavier Becerra, No. 22-5214 (D.C. Cir. 2023)
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Hospitals treating Medicare beneficiaries receive greater reimbursements to the extent that the beneficiaries are also entitled to supplemental security income benefits under Title XVI of the Social Security Act. The Secretary of Health and Human Services understands this population to include only patients receiving cash payments during the month in question. Various hospitals contend that this population also includes patients receiving a subsidy under Medicare Part D and vocational training. The district court disagreed and granted summary judgment to the Department of Health and Human Services (HHS).
The DC Circuit affirmed. The court explained that the hospitals argued that Empire compels their construction of the phrase “entitled to supplementary security income benefits.” The court wrote that this s argument misses key distinctions between the Part A and SSI schemes. First, Part A benefits extend well beyond payment for specific services at specific times. Moreover, the court explained that age or chronic disability makes a person eligible for Part A benefits “without an application or anything more,” and individuals rarely, if ever lose this eligibility over time.
Moreover, the court explained that the hospitals contend that HHS arbitrarily excluded patients whose SSI benefits were withheld under the so-called “cross-program recovery” scheme. The court reasoned that this assertion is mistaken. Next, the court explained that the hospitals contend that HHS unreasonably focused on whether patients receive SSI payments when hospitalized because the payments depend on income and resource levels from earlier months. But “eligibility” for the SSI benefit “for a month” depends on the individual’s income, resources, and other characteristics “in such month.”
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