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

Nursing home resident dies after intoxicated son smothers him

A terminally ill nursing home resident died after his intoxicated son tries to suffocate him, local police say. Roy Curtis, 86, reportedly died hours after his son was arrested.

Medicare rates could be adjusted for start and end of hospice care ...

Medicare payments could be adjusted to reflect how hospice services tend to be more intensive at the beginning and end, according to findings recently published by the Centers for Medicare & Medicaid Services Office of Information Products & Data Analytics.

Medicare should pay for skilled nursing services without a qualifying hospital stay, experts tell Senators

Medicare should pay for skilled nursing services without ...

The time has come to eliminate hospital stay requirements for beneficiaries to qualify for Medicare coverage of skilled nursing services, experts told a Senate committee Wednesday.