Battle Creek Health System v. Robert F. Kennedy Jr.

CourtCourt of Appeals for the D.C. Circuit
DecidedAugust 22, 2025
Docket23-5310
StatusPublished

This text of Battle Creek Health System v. Robert F. Kennedy Jr. (Battle Creek Health System v. Robert F. Kennedy Jr.) is published on Counsel Stack Legal Research, covering Court of Appeals for the D.C. Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Battle Creek Health System v. Robert F. Kennedy Jr., (D.C. Cir. 2025).

Opinion

FOR THE DISTRICT OF COLUMBIA CIRCUIT

Argued November 22, 2024 Decided August 22, 2025

No. 23-5310

BATTLE CREEK HEALTH SYSTEM, ET AL., APPELLEES

v.

ROBERT F. KENNEDY, JR., SECRETARY OF THE UNITED STATES, DEPARTMENT OF HEALTH AND HUMAN SERVICES, APPELLANT

Appeal from the United States District Court for the District of Columbia (No. 1:17-cv-00545)

Kevin J. Kennedy, Attorney, U.S. Department of Justice, argued the cause for appellant. With him on the briefs were Brian M. Boynton, Principal Deputy Assistant Attorney General, Matthew M. Graves, U.S. Attorney, Abby C. Wright, Attorney, Samuel R. Bagenstos, General Counsel, U.S. Department of Health and Human Services, Janice L. Hoffman, Associate General Counsel, Susan Maxson Lyons, Deputy Associate General Counsel, and James F. Segroves, Attorney.

Andrew B. Howk argued the cause for appellees. With him on the brief was Heather D. Mogden. 2

Jonathan C. Bond and Robert A. Batista were on the brief for amici curiae American Hospital Association, et al. in support of appellees.

Mark D. Polston, Christopher P. Kenny, and Nikesh Jindal were on the brief for amici curiae Florida Hospital Association, et al. in support of appellees.

Before: SRINIVASAN, Chief Judge, WALKER, Circuit Judge, and EDWARDS, Senior Circuit Judge.

Opinion for the Court filed by Chief Judge SRINIVASAN.

SRINIVASAN, Chief Judge: The Medicare program reimburses hospitals for providing services to covered patients. Hospitals that treat a disproportionate number of low-income patients are eligible to receive an upward adjustment to offset the increased treatment costs. That adjustment is known as the disproportionate share hospital (or DSH) adjustment.

In this case, a group of hospitals seeks to contest the way in which one component of the DSH adjustment was determined for fiscal year 2007. We have no occasion to engage with the merits of their challenge. The administrative body that hears such challenges, the Provider Reimbursement Review Board, dismissed the hospitals’ claim in this case on the ground that it was brought too early. According to the Board, the hospitals needed to wait until they knew the final amount of their DSH adjustment rather than just the determination of one component of it. The district court disagreed and concluded that the hospitals’ challenge could go forward. Because we agree with the Board, we reverse the district court. 3 I.

A.

Medicare “provides health insurance to Americans who are 65 or older, as well as to disabled Americans.” Allina Health Servs. v. Price, 863 F.3d 937, 938 (D.C. Cir. 2017) (Allina II); 42 U.S.C. § 1395 et seq. The program is administered by the Centers for Medicare and Medicaid Services (CMS) within the Department of Health and Human Services.

1. Medicare Part A provides eligible individuals with “government-administered health insurance.” Allina II, 863 F.3d at 938. Under Part A, the government pays hospitals directly for services rendered to covered patients. See Azar v. Allina Health Servs., 587 U.S. 566, 570 (2019) (Allina III). Part C, meanwhile, covers individuals who enroll in private rather than government-administered health insurance plans, and the government pays the insurance premiums rather than the hospitals directly for care. See id.; 42 U.S.C. §§ 1395w- 21–29; Northeast Hosp. Corp. v. Sebelius, 657 F.3d 1, 2–3 (D.C. Cir. 2011).

Before 1983, Medicare reimbursed hospitals for the “reasonable costs” they incurred to furnish care to covered patients. See Methodist Hosp. of Sacramento v. Shalala, 38 F.3d 1225, 1226–27 (D.C. Cir. 1994). Because reimbursements depended on a hospital’s actual costs (subject to reasonableness limitations), the final determination of the reimbursement amount owed to a hospital was made after the end of the fiscal year, based on the hospital’s year-end cost report. See Washington Hosp. Ctr. v. Bowen, 795 F.2d 139, 141 (D.C. Cir. 1986). A document called the “Notice of Program Reimbursement” (or NPR), produced after the end of 4 the fiscal year, contained the final determination of the total reimbursement owed to a provider. See id. NPRs continue to serve that function today.

In 1983, Congress “completely revised” the method for determining the reimbursement amounts. Methodist Hosp., 38 F.3d at 1227; Social Security Amendments of 1983, Pub. L. No. 98-21, § 1886(d)(1)–(4) (codified as amended at 42 U.S.C. § 1395ww(d)(1)–(4)). Congress instituted the Prospective Payment System (PPS), under which reimbursements are based on prospectively determined standard rates for a given type of diagnosis rather than on a retrospective determination of a hospital’s actual treatment costs. See Washington Hosp. Ctr., 795 F.2d at 141–42. Under the PPS, that is, hospitals are generally reimbursed at “a fixed rate for treating each Medicare patient . . . based on the patient’s diagnosis and regardless of the hospital’s actual costs.” Becerra v. Empire Health Found. for Valley Hosp. Med. Ctr., 597 U.S. 424, 429 (2022). The standard reimbursement rates are generally known as the “federal rates.” See 42 C.F.R. § 412.64. And because the federal rates are fixed prospectively, hospitals know in advance the reimbursement rates they will receive for services they will render in any year.

2. The Medicare statute also provides for certain adjustments to a hospital’s reimbursement rates. This case involves one such adjustment: the “disproportionate share hospital” (or DSH) adjustment. 42 U.S.C. § 1395ww(d)(5)(F). The DSH adjustment compensates hospitals that “serve[] a significantly disproportionate number of low-income patients,” id. § 1395ww(d)(5)(F)(i)(I), who “are often more expensive to treat than higher income ones, even for the same medical conditions,” Empire Health, 597 U.S. at 429. 5 The amount of a hospital’s DSH adjustment depends on the level of its “disproportionate patient percentage,” a proxy for the extent to which the hospital serves low-income patients. 42 U.S.C. § 1395ww(d)(5)(F)(v). To be eligible for a DSH adjustment, a hospital must have a disproportionate patient percentage that exceeds 15%. Id. “The higher the disproportionate-patient percentage goes, the greater the rate mark-up that the hospital will receive.” Empire Health, 597 U.S. at 432.

A hospital’s disproportionate-patient percentage is the sum of two fractions, both defined by statute. See Allina Health Servs. v. Sebelius, 746 F.3d 1102, 1105 (D.C. Cir. 2014) (Allina I). The first is the “Medicare fraction” and the second is the “Medicaid fraction.” Id.

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Battle Creek Health System v. Robert F. Kennedy Jr., Counsel Stack Legal Research, https://law.counselstack.com/opinion/battle-creek-health-system-v-robert-f-kennedy-jr-cadc-2025.