Medicare days in hospital payments
Becerra v. Empire Health Foundation
In brief
Qualifying for Medicare Part A is enough to count a patient's hospital day in the payment formula, even if Medicare paid none or only part of the stay; the Court overturned the Ninth Circuit and sent the case back (remanded).
- Where it stands
- Decided
Decided 5-4 · June 24, 2022 · Opinion by Justice Kagan
- What it’s about
- This case was about how the federal government calculates extra Medicare payments for hospitals that treat many low-income patients.
- Who it affects
- The ruling requires a broader count of patient days in the Medicare fraction, which helps calculate extra Medicare payments for hospitals serving many low-income patients. The Ninth Circuit must now apply that rule to the hospital's calculation.
Summary: written with AI from the case record.
What it's about
The dispute centered on whether patients who qualify for Medicare Part A count in the Medicare part of that formula even if Medicare did not actually pay for their hospital stay, and the Court held that they do.
A technical definition in Medicare law can affect payments to hospitals serving low-income patients.
Question presented
Whether the Secretary has permissibly included in a hospital's Medicare fraction all of the hospital's patient days of individuals who satisfy the requirements to be entitled to Medicare Part A benefits, regardless of whether Medicare paid the hospital for those particular days.
What the Court decided
Holding
In calculating the Medicare fraction, individuals “entitled to [Medicare Part A] benefits” are all those qualifying for the program, regardless of whether they receive Medicare payments for part or all of a hospital stay. 958 F. 3d 873, reversed and remanded.
- Result
- Reversed
The vote
From the opinions
“In my view, the answer to that narrow question is straightforward and commonsensical: No.”
What's next
The Ninth Circuit will now apply the Supreme Court's counting rule to the hospital's reimbursement calculation after the case was sent back (remanded). The ruling does not itself set the hospital's final payment.
Documents
Docket activity
New analysis added
AI analysis generated: Case Briefing
New analysis added
AI analysis generated: Impact Analysis
AI analysis generated: Opinion Summary
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AI analysis generated: Decision Record
Case data updated: status, opinion_date
Opinion added: opinion
Brief added: Petition
Brief added: Questions Presented
More questions
- What did Becerra v. Empire Health Foundation decide?
- The Court decided that people who qualify for Medicare Part A count in the Medicare fraction, a part of the payment formula. That rule applies even when Medicare paid none or only part of the stay.
- How does the ruling affect Medicare payment calculations?
- It requires patient days for people who qualify for Medicare Part A to count, even when Medicare did not pay for them. That fraction helps determine extra payments for hospitals serving many low-income patients.
- What did the Supreme Court do to the Ninth Circuit's ruling?
- It overturned the Ninth Circuit's ruling and sent the case back to that court (remanded).
- What happens next for the hospital's case?
- The Ninth Circuit will apply the Supreme Court's counting rule to the hospital's reimbursement calculation. The ruling does not itself set the hospital's final payment.
Sources
Primary materials plus reporting. Best-effort analysis: this explainer relies on a mix of primary materials and trusted secondary sources. Official filings and opinions remain authoritative.