CMS published a proposed rule today that would prohibit federal funds from going to the states to pay for medical care for a broader category of healthcare-acquired conditions.
The rule goes beyond the Medicare inpatient nonpayment rule for healthcare-acquired conditions that went into effect in October 2007 by extending the nonpayment concept to state Medicaid programs. Whether it will be more successful than the Medicare no-pay policy, which barely made a dent so far as payment adjustments are concerned, is unclear.
The draft rule also authorizes states to identify a wider category of healthcare-acquired conditions it calls "provider-preventable conditions" (PPCs), which will not be covered by Medicaid payments. PPCs are an umbrella term CMS came up with to signify hospital and nonhospital conditions the state will not pay for.
The proposed rule was mandated by section 2702 of the Affordable Care Act and would go into effect July 1, 2011. Public comments will be accepted up through March 18, 2011. To submit comments on the proposed rule, see contact information on page 9291.
So far 21 states have nonpayment policies on the books related to HACs. At least half of existing policies exceed Medicare's current HAC requirements and rules, either in the conditions identified, the systems used to indicate the conditions, or the settings where the nonpayment policies can be applied.
To learn more:
- read the proposed rule in the Federal Register
- read the Health Data Management article