CMS Proposes Medicaid Payment Adjustment for "Provider-Preventable Conditions"
On February 17, 2011, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule prohibiting Medicaid payments for care associated with “provider-preventable conditions” (PPCs). CMS would use the term PPC as an umbrella term for hospital and nonhospital conditions identified by the state for nonpayment. PPCs would encompass health-care acquired conditions, as defined for Medicare purposes, and other PPCs applicable to other conditions and service settings beyond the inpatient hospital setting (CMS notes that preventable conditions can occur in outpatient hospital, nursing facility, and ambulatory care settings). The policy is mandated by the ACA, which requires the regulations to be effective July 1, 2011. CMS will accept comments on the proposed rule until March 18, 2011.
