The final rule enacts a provision of the federal health reform law that bars states from paying health care providers for conditions deemed "reasonably preventable," according to MedPage Today. Although the final rule takes effect on July 1, 2011, states have until July 1, 2012, to implement the program under the overhaul (Walker, MedPage Today, 6/1).
Twenty-one states already have instituted nonpayment policies for preventable conditions (McKinney, Modern Healthcare, 6/1).
List of Preventable Conditions
Medicaid's list of preventable conditions closely mirrors the list used for Medicare, which stopped reimbursing hospitals for such conditions in 2008 (MedPage Today, 6/1).
The final rule requires states at minimum to adopt the Medicare list, but it also allows them to implement "more stringent laws or regulations" if approved by CMS (Modern Healthcare, 6/1). Conditions on the Medicaid list include:
Falls that result in injury;
Foreign object retained after surgery;
Severe bedsores; and
Surgical site infections (Fox, National Journal, 6/1).
'Never Events' Policy
According to MedPage Today, CMS also has issued National Coverage Decisions, which state that Medicare will not pay for certain "never events," such as performing the wrong procedure, performing a procedure on the wrong body part and performing a procedure on the wrong patient. Medicaid also is expected to cease payment for never events (MedPage Today, 6/1).
"These steps will encourage health professionals and hospitals to reduce preventable infections, and eliminate serious medical errors," CMS Administrator Donald Berwick said. He added, "As we reduce the frequency of these conditions, we will improve care for patients and bring down costs at the same time" (National Journal, 6/1).