Batavia A I, Ozminkowski R J, Gaumer G, Gabay M
Georgetown University School of Medicine, Washington, DC.
Health Care Financ Rev. 1993 Winter;15(2):137-54.
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.
在1990年最高法院一项裁决的鼓舞下，医疗补助提供者依据《博伦修正案》对州住院费用设定方法提出了质疑。从程序上讲，各州向美国卫生与公众服务部（DHHS）做出的支付费率符合该修正案要求的保证，必须有基于合理原则性分析得出的调查结果作为支撑。从实质上讲，费率可能处于合理区间内，但法院在解释和适用该修正案条款时存在分歧。尽管一些法院认为特殊研究和书面调查结果并非必要，但进行经济分析以支持其调查结果的州更有可能经受住司法审查。本文提出了几种适用的经济分析方法。
