Non-Payment
Providers can prevent many health care-acquired conditions. Medicaid agencies can create an incentive for providers to increase their efforts to prevent these conditions by ceasing to pay for their treatment—ultimately reducing their occurrence.
*Milestone details:
*Full name: Establish Medicaid non-payment policies for health care-acquired conditions.
*Relevance to the ACA:
According to the ACA, states will no longer receive federal matching dollars for any payments made through the Medicaid program for medical expenses associated with certain health care-acquired conditions with the stipulation that the prohibition on payment for health care-acquired conditions shall not result in a loss of access to care or services for Medicaid beneficiaries (§2702 effective July 1, 2011).
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District of Columbia
Pennsylvania Medicaid's adverse event non-payment policy is available online.
District of Columbia
Additional information on Pennsylvania's policies is available here.
District of Columbia
Missouri's adverse event nonpayment policy for health care-acquired conditions is available online. See page 36.
District of Columbia
New Jersey enacted legislation in 2009 that prohibits, "A general hospital ...[from] seek[ing] to obtain payment from a patient or any third party payer for costs associated with any of the following conditions or events subject to the hospital acquired condition payment policy for the Medicare program established by the Centers for Medicare and Medicaid Services: transfusion reaction; air embolism; foreign body left during the procedure; surgery on the wrong side, wrong body part, or wrong person; or wrong surgery performed on a patient."
The entire law is available through the link below.
Maine
Massachusetts prohibits hospitals from seeking reimbursement for "serious reportable events." Further information is available online.
Maine
The attached legislation prohibits health care facilities from "knowingly charging a patient or the patient's insurer for health care services it provided as a result of or to correct a mistake or preventable adverse event caused by that health care facility." The legislation lists 28 mistakes/preventable adverse events.
Oregon
Oregon's Public Employers Health Purchasing Committee endorses Oregon Health Policy Board contract provisions relating to patient safety similar to those used by PEBB and OEBB and recommends that public and private employers in Oregon discuss with their carrier or third-party administrator including patient safety standards in their contracts. See the standards here.
Washington
Adverse events, hospital-acquired conditions, and present on admission indicators
Maine
This report by the New York State Health Foundation details the challenges and opportunities NY faces in implementing reform, including Exchange, benefit design, and payment issues. The report includes discussion of NY's existing Medicaid "never event" nonpayment policy (page 74, page 79 of the PDF). Access the report here: http://www.statereforum.org/sites/default/files/nyroadmappaper_aug2010.pdf
Maine
Dr. Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene, has posted an excellent presentation entitled "The Opportunities and Challenges of Health Care Delivery Reform." The presentation discusses Maryland's policy for reducing hospital acquired conditions. To download the presentation, please follow this link:
http://www.statereforum.org/node/1400#shinecomment-6821
Maryland
We have implemented a Maryland Hospital Acquired Conditions iniitiative in 2009 that applies statewide to all acute care hospitals and to all payers. Under the program, hospital performance rates are monitored on a robust set of 49 potentially preventable complications and payment adjustments are made annually based on performance.
Additional information may be found at this link:
http://76.12.205.105/init_qi_MHAC.cfm