CMS Issues Final Rule Limiting Medicaid Payments to States for Healthcare-Acquired Conditions (HACs)

June 1, 2011

The final rule prohibiting federal Medicaid payments to states for a number of preventable healthcare-acquired conditions was issued by the Centers for Medicare & Medicaid Services (CMS) today (June 1, 2011).

The final rule is required by the Patient Protection and Affordable Care Act.  It becomes effective on July 1, 2011. States have the option to delay implementation until July 1, 2012 however.

The rule is applicable to all Medicaid inpatient hospitals and is based on Medicare’s list of preventable healthcare-acquired conditions (HACs) with adjustments made for differences in the Medicare and Medicaid patient populations.

Included within the list of HACs subject to nonpayment are three healthcare-associated infections:  catheter-associated urinary tract infections (CAUTI), vascular catheter-associated infection, and surgical site infections (SSI) following coronary artery bypass grafts, bariatric surgeries, and orthopedic procedures (spine, neck, shoulder, and elbow).

Click to read the final rule.

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