CMS’ Final HAC Rule Baffles Hospitals

Cheryl Clark, for HealthLeaders Media , June 9, 2011

Most states with specific Medicaid HAC policies identify at least half of Medicare's current list of HACS, and "nearly half of those states defined a list that was different than Medicare's current list of HACs for nonpayment."

Feldpush pointed to other parts of the rule that provoke questions, such as:


  • Does the rule apply to critical access hospitals, which make up one in four hospitals in the country?
  • Will states with a longer list of provider-preventable conditions than what is required for the base be obligated to pay hospitals the federal portion of those costs?
  • What about payments Medicaid makes to managed care plans? When a provider preventable condition occurs, will states demand a refund?
  • Also unclear is how the policy would affect hospital systems with facilities in multiple states with different OPPC lists. "Many hospitals belong to health systems that cross several state borders," AHA executive vice president Rick Pollack said in a comment letter to CMS March 18. "If states are able to finalize completely different lists of healthcare-acquired conditions, it would be extremely difficult to manage across a health system....We strongly recommend that CMS and states focus on a core set of healthcare-acquired conditions that are consistent across all states."

What's at stake?
CMS estimates minimal financial impact when the rule takes effect in July 2012, with denied payments amounting to only $20 million for the federal share and $15 million for the state share for each year through 2015. However, the agency says, "these estimates could be higher if states elect to expand beyond the minimum requirements of this rule."  It also doesn't indicate what hospitals will be required to absorb.

One issue CMS did clear up in the rule is that it will not restrict payment to a hospital that fixed a mistake another hospital made. This could pave the way for a hospital exchange of patients who had endured harm, even if it is an extremely informal one.

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