181778P.pdf   11/04/2019  Missouri Hospital Association  v.  Alex Azar, II
   U.S. Court of Appeals Case No:  18-1778
   U.S. District Court for the Western District of Missouri - Jefferson City   
   [PUBLISHED] [Loken, Author, with Wollman and Stras, Circuit Judges] 
   Civil Case - Medicaid. The Secretary of HHS appeals district court's grant 
   of summary judgment to Missouri Hospital Association, which challenged the 
   final rule (42 U.S.C. sec 1396r-4(g)(1)(A)) defining "costs incurred" as 
   "costs net of third-party payments, including, but not limited to payments 
   by Medicare and private insurance" in calculating disproportionate share 
   hospital payments. The district court concluded the Rule was contrary to 
   language in the statute explaining that only payments that offset Medicaid 
   costs are non-DSH Medicaid payments. The statute does not delegate to the 
   Secretary unfettered discretion to determine "costs incurred"; the terms 
   "costs incurred" and "net of payments" do not have plain, unambiguous 
   meanings; and MHA's interpretation is not plainly mandated by the statute. 
   The Secretary's interpretation is reasonable in light of the statute's 
   purpose and design. Taking into account payments by private insurance 
   ensures that only "uncompensated care costs" are reimbursed. The district 
   court's orders are reversed. Judge Stras concurs in the judgment.