June 2, 2011

CMS: No Medicaid Pay for HACs

By + Coronary Artery Bypass Graft (CABG)

The Centers for Medicare & Medicaid Services says it will no longer pay providers for specific Healthcare Acquired Conditions.

In issuing its Final Rule yesterday (June 2, 2011), CMS said the new rule prohibits states from making payments to providers under the Medicaid program for conditions that are “reasonably preventable.” CMS will use Medicare’s list of preventable conditions in inpatient hospital settings as the base (adjusted for the differences in the Medicare and Medicaid populations) and provides states the flexibility to identify additional preventable conditions and settings for which Medicaid payment will be denied.

The final rule is effective July 1, 2011 but gives States the option to implement between its effective date and July 1, 2012.

The following is a list of the Medicare HACs for FY 2011 (75 FR 50084 through 50085):

- Foreign Object Retained After Surgery.

- Air Embolism.

- Blood Incompatibility.

- Stage III and IV Pressure Ulcers.

- Falls and Trauma.

+ Fractures.
+ Dislocations.
+ Intracranial Injuries.
+ Crushing Injuries.
+ Burns.
+ Electric Shock.

- Manifestations of Poor Glycemic Control.

+ Diabetic Ketoacidosis.
+ Nonketotic Hyperosmolar Coma.
+ Hypoglycemic Coma.
+ Secondary Diabetes with Ketoacidosis.
+ Secondary Diabetes with Hyperosmolarity.

- Catheter-Associated Urinary Tract Infection (UTI).

- Vascular Catheter-Associated Infection.

- Surgical Site Infection Following:

+ Coronary Artery Bypass Graft (CABG) –

- Mediastinitis.

+ Bariatric Surgery.

- Laparoscopic Gastric Bypass.

- Gastroenterostomy.

- Laparoscopic Gastric Restrictive Surgery.

+ Orthopedic Procedures.

- Spine.
- Neck.
- Shoulder.
- Elbow.

- Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE).