HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Thursday, June 2, 2011

Hospital-Acquired Conditions and Medicaid

According to ACA Section 2702

The Secretary ... shall identify current State practices that prohibit payment for health care- acquired conditions and shall incorporate the practices identified, or elements of such practices, which the Secretary determines appropriate for application to the Medicaid program in regulations.

The purpose of this provision was to better align Medicaid policies with the Medicare position taken in 2008. That is, there should be no remuneration for so-called "never events," a subset of "Hospital-Acquired Conditions" (HACs). Examples include retained objects and some falls and infections.

The new Medicaid rule is now available here. As noted in the Background section of the new rule (at 17) there are considerable differences among the 21 states that already have HAC reimbursement prohibitions, even though many states do use the Medicare HAC list, available here. As a result the new Medicaid rule adopts a federal floor and permits states to have some more stringent requirements. The compliance date for the new regulation has been pushed back to July 1, 2012


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