Medicaid Implements “Preventable Condition” Rule

Effective July 1, 2012, Arkansas Medicaid will be implementing 42 CFR 477.26 (c)(1); which requires that all state Medicaid plans prohibit payment for “provider-preventable conditions.” The umbrella term “provider-preventable conditions” (PPCs) includes two separate categories: “healthcare-acquired conditions” (HCACs) and “other provider-preventable condition” (OPPC). HCACs apply to Medicaid inpatient hospital settings and are generally defined to include the full list of Medicare’s previous inpatient “hospital-acquired conditions” (HAC). Other provider preventable conditions that Arkansas Medicaid will be prohibiting payment for in any healthcare setting will be wrong surgical or other invasive procedures performed on a patient, surgical or other invasive procedures performed on the wrong body part or surgical or other invasive procedures performed on the wrong patient. This is cost neutral.