Opinion ID: 730847
Heading Depth: 3
Heading Rank: 3

Heading: For such days

Text: 26 Both the Secretary and the hospitals look to the parenthetical for such days in the Medicaid proxy to bolster their interpretation. The statute reads: the number of the hospital's patient days for such period which consist of patients who (for such days) were eligible for medical assistance under a State plan ... 42 U.S.C. § 1395ww(d)(5)(F)(vi)(II). The Secretary insists that for such days refers back to patient days earlier in the sentence, that it should be read for such [patient] days and that it should limit the Medicaid fraction to patient days for which the Medicaid patient was eligible to have his or her [hospital] care paid for by the Medicaid program. 51 Fed.Reg. 31460 (Sept. 3, 1986). In other words, the Secretary argues that for such days ties medical assistance to inpatient hospital care, and precludes reading medical assistance as referring to any of the other twenty-four services listed in § 1396d. 27 We cannot adopt the Secretary's reading of for such days because it runs contrary to a specific definition set forth by Congress. Section 1396d defines medical assistance to include twenty-five medical services. If Congress had wanted medical assistance to take on a completely different meaning in the context of this Medicaid proxy provision of the DSH calculation, Congress could easily have so indicated. We cannot infer from an oblique for such days parenthetical that Congress was superseding its own statutory definition. Our dissenting brother relies on the parenthetical to drive the interpretation of the whole provision, thereby allowing the statutory tail to wag the dog. A parenthetical is, after all, a parenthetical, and it cannot be used to overcome the operative terms of the statute. 28 We believe that for such days modifies the phrase in which it is embedded: patients who (for such days) were eligible. Read with an eye to grammatical proximity, for such days clarifies that a patient should be counted only for the days on which he meets the income and resource qualifications; if he acquires resources part way through his hospital stay such that he no longer is eligible for Medicaid, then his days beyond that point are not to be counted in the fraction. Similarly, if a patient is ineligible for Medicaid when he enters the hospital, but depletes his resources such that he becomes eligible part way through his stay, his hospital days prior to eligibility should not be counted in the DSH calculation. See Legacy Emanuel Hosp. & Health Center v. Shalala, 97 F.3d 1261, 1265-66 (9th Cir.1996) (interpreting for such days to preclude those days on which patient, due to change in status, is ineligible for medical assistance). 29 The Secretary argues that the rest of the sentence, if interpreted in this manner, renders for such days essentially repetitive and meaningless. We disagree. To the contrary, for such days is necessary to specify that patients who met the Medicaid eligibility requirements during only part of their stay are counted only on their eligible days. Without for such days, the statute might be interpreted to include all the days a patient was in the hospital, as long as he was eligible for Medicaid at some point during the stay.