New rule would crack down on payments for facility-acquired 'conditions'

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The Centers for Medicare & Medicaid Services on Wednesday proposed a new rule that would deny states federal money—of any amount—to help cover costs associated with adverse hospital-acquired conditions.

This rule affects conditions included on Medicare's list of hospital-acquired conditions, as well as those identified by the state as preventable or adverse, regardless of the of healthcare setting where they occur. CMS also gives states authorization to decide on their own which conditions are preventable and thus not available for federal assistance, including wrong site, procedure or patient surgery. It would be up to Medicaid state plans to alter guidelines for lowering provider payments for healthcare-acquired conditions.

The proposal, which is currently being reviewed by major U.S. long-term care associations, says state plans must be able to identify what percentage of provider payments go to treating these kinds of conditions. State plans also must make sure beneficiaries have access to services.

The proposed rule is being published in today's Federal Register. Officials will be collecting stakeholder comments on it for 30 days.

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