Payment Matters: CMS Proposes Rule for Medicaid Nonpayment in the Event of Health Care Acquired Conditions

more+
less-

CMS has released a proposed rule, which would implement the Affordable Care Act’s requirement that state Medicaid plans must disallow payment for care and services related to health care acquired conditions (HCACs) and other provider-preventable conditions (OPPCs). The proposed rule would require states to adopt Medicare’s existing payment prohibitions for hospital acquired conditions, and would extend those prohibitions to conditions acquired by Medicaid beneficiaries in non-hospital settings. Under the proposed rule, states would be required to establish a provider self-reporting mechanism for HCACs and OPPCs.

Health professionals that treat Medicaid patients should familiarize themselves with the list of hospital acquired conditions, which all state Medicaid plans would target for nonpayment under the proposed rule. The current list of hospital acquired conditions may be viewed here (see full alert below for link). States would also be able to establish OPPCs based on the following criteria: the condition or event must be (1) discrete, auditable, quantifiable, and clearly defined; (2) clearly adverse, resulting in negative consequence of care that results in unintended injury or illness; and (3) reasonably preventable, meaning an event that could have been anticipated and prepared for, but that occurs because of an error or other system failure.

Comments must be received no later than March 18, 2011.

Please see full alert below for more information.

LOADING PDF: If there are any problems, click here to download the file.


DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Ober|Kaler | Attorney Advertising

Written by:

more+
less-

Ober|Kaler on:

JD Supra Readers' Choice 2016 Awards
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:

Sign up to create your digest using LinkedIn*

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.

Already signed up? Log in here

*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.
×
Loading...
×
×