CMS Issues Final Rule On Medicaid Payment for HACs

The Centers for Medicare & Medicaid Services released a final rule prohibiting federal Medicaid payments to states for certain preventable health care-acquired conditions. Required by the Patient Protection and Affordable Care Act, the rule is effective July 1, 2011, but gives states the option to delay implementation through July 1, 2012. The rule applies to all Medicaid inpatient hospitals based on Medicare's list of preventable conditions - adjusted for differences in the Medicare and Medicaid populations.

In addition, it applies to wrong site, procedure or patient surgeries in inpatient and outpatient settings, and allows states to expand these additional preventable conditions and settings with CMS approval, based on criteria set forth in the regulation. AHA is reviewing the rule and will provide more information to members soon. In comments submitted to CMS in March, AHA urged CMS to work with states to agree on a consistent set of Medicaid health care-acquired conditions before prohibiting Medicaid payment for HACs, and to use the current list of Medicare HACs as the sole source for selecting Medicaid HACs. The association also asked that CMS "work with states to establish a responsible delay" of the start date to give states time to implement and educate providers about the changes.

06-03-2011 01:41 (EDT)