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Title
Lessons for states in inpatient ratesetting under the Boren Amendment.
First Author
Batavia, Andrew I
Date of Pub
1993 Winter
Pages
137-154
Volume
15
Issue
2
Other Authors
Gabay, Mary; Gaumer, Gary L; Ozminkowski, Ronald J
Abstract
Encouraged by a 1990 Supreme Court decision, Medicaid providers have challenged State inpatient ratesetting methodologies under the Boren Amendment. Procedurally, State assurances to the U.S. Department of Health and Human Services (DHHS) that payment rates meet the Amendment's requirements must be supported by findings based on a reasonably principled analysis. Substantively, rates may fall within a zone of reasonableness, but courts have differed in interpreting and applying the Amendment's terms. Although some courts have found special studies and written findings unnecessary, States that undertake economic analyses to support their findings are more likely to withstand judicial scrutiny. Several applicable economic analyses are proposed.
Abstract Continued
N/A
MeSH
Cost Control/legislation & jurisprudence : Efficiency, Organizational/economics : Financial Management, Hospital/legislation & jurisprudence : Health Services Research : Hospital Costs/legislation & jurisprudence : Insurance, Health, Reimbursement/legislation & jurisprudence : Medicaid/economics/legislation & jurisprudence : Rate Setting and Review/legislation & jurisprudence/methods/standards : Regression Analysis : Residential Facilities/economics/legislation & jurisprudence : State Health Plans/economics/legislation & jurisprudence : United States : United States Health Care Financing Administration
NTIS Number
PB95-123469