Lessons for states in inpatient ratesetting under the Boren Amendment.
Batavia, Andrew I
Date of Pub
Gabay, Mary; Gaumer, Gary L; Ozminkowski, Ronald J
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.
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