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

RACs collected nearly $2 million from skilled nursing facilities last year, report ...

Recovery Audit Contractors recovered $1.8 million in Medicare overpayments made to skilled nursing facilities in fiscal year 2013, according to a Congressional report released Monday.

OK nursing home worker threatened to behead colleague in a terrorist act, ...

Police in Oklahoma City have arrested a nursing home worker who allegedly threatened to behead another staff member out of solidarity with the Islamic State in Iraq and Syria, according to news sources.

Jewish Home Lifecare named Innovator of the Year

Jewish Home Lifecare named Innovator of the Year

Jewish Home Lifecare won the top award in the Innovator of the Year category in the third annual McKnight's Excellence in Technology Awards competition.