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Health-Care-Acquired Conditions – Prohibition on Federal Reimbursements

As of July 1, 2011, Federal payments to States are prohibited for any amounts expended for providing medical assistance for health-care-acquired conditions (SSA § 1903 and Patient Protection and Affordable Care Act § 2702). Federal regulations prohibit Medicaid payments by States for services related to health-care-acquired conditions and for provider preventable conditions as defined by Centers for Medicare & Medicaid Services or included in the Medicaid State Plan (42 CFR § 447.26). We will determine whether selected States made Medicaid payments for hospital care associated with health-care-acquired conditions and provider preventable conditions and quantify the amount of Medicaid payments for such conditions.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services Health-Care-Acquired Conditions – Prohibition on Federal Reimbursements Office of Audit Services W-00-17-31452; various reviews 2018

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