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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)
Completed (partial) Centers for Medicare & Medicaid Services Health-Care-Acquired Conditions - Prohibition on Federal Reimbursements Office of Audit Services A-06-16-08004; various reviews 2018

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201