CMS: Medicaid should follow Medicare on 'never event' payment policies

Share this article:
The Centers for Medicare & Medicaid Services is asking states to coordinate their Medicaid policies with Medicare's hospital-acquired condition payment policy so states do not bear the burden of paying for adverse events.

In a July 31 letter to state Medicaid directors, CMS noted that many Medicare beneficiaries are dual eligibles, or those who qualify for Medicare and Medicaid. To avoid payment liability, they may choose to alter their Medicaid state plans to deny payment for serious adverse events no longer paid for by Medicare. Many nursing-home residents are dual eligibles.

Beginning Oct. 1, CMS will not pay hospitals additional money for 10 conditions, including three newly added conditions, if they were not reported as present upon admission. The new preventable conditions on the "do not pay" list are surgical site infections following elective surgical procedures, some conditions arising from poor control of blood sugar, and deep vein thrombosis that develops after knee or hip replacement surgery.

To view CMS' July 31 letter detailing the new "never events" and its recommendations to states, visit http://www.cms.hhs.gov/SMDL/downloads/SMD073108.pdf.
Share this article:

More in News

Long-term care continues to lead in deal volume and value: PwC report

Long-term care continues to lead in deal volume ...

Long-term care bucked healthcare industry trends with strong merger and acquisition activity in the second quarter of 2014, according to newly released data from professional services firm PricewaterhouseCoopers.

Empowering nurse practitioners could reduce hospitalizations from SNFs, study finds

Granting more authority to nurse practitioners is associated with reduced hospitalization of skilled nursing facility residents, according to recently published findings.

Pioneer ACO drops out of program, despite reductions in skilled nursing utilization

A California healthcare system has become the latest dropout from the Pioneer Accountable Care Organization program, despite reducing skilled nursing facility utilization and improving its readmission rates. Sharp HealthCare announced its decision in a quarterly financial statement released Tuesday.