Case: Montefiore Medical Center v. Robert F. Kennedy, JR.
Court: U.S. District Court for the District of Columbia
Decision Date: September 30, 2025
Overview:
A 2023 Rule retroactively applied “entitled to benefits under Part A for pre 2014 adjustments.”
The District Court decision this week determined “the 2023 Rule reflecting that interpretation is both impermissibly retroactive and arbitrary and capricious. Consequently, the rule is unlawful [sic]…”
Remedy for the unlawful rule is pending further proceedings on supplemental briefs that are to be submitted this month.
Implications for Providers:
- Hospitals who have received pre-2014 adjustments may want to seek appeals.
- Hospitals with realignments “in process” for pre-2014 years may want to seek injunction to prevent those requests from processing based on this case law to prevent a possible loss of reimbursement.
- Hospitals who rushed to realign pre-2014 SSI ratios (“one time right”) may have foregone additional reimbursement and could consider legal action or could choose to wait and see if the remedy to this case provides them relief.
- Hospitals should monitor the remedy in this case, which has not yet been determined by the court, and any related appeals of the case should they follow.
If you have questions regarding Medicare DSH, SSI ratios, or 340B qualification please contact Adam Blackwell: adamblackwell@govdataservices.com
The CASE ruling can be found here: Montefiore Case 1:2024cv01810