New CMS Final Rule Allows Medicaid to Deny Payment for Healthcare-Acquired Illnesses

On Wednesday, CMS issued a final rule that prohibits or reduces Medicaid payments to doctors, hospitals and other healthcare providers for services that result in preventable healthcare-acquired illnesses or injuries. The list of preventable conditions includes falls and trauma, blood incompatibility, catheter-associated UTIs, pressure ulcers and poor glycemic control, among others.

The goal of the rule, which is based on Medicare policies being successfully used in hospitals, is to lower states' Medicaid costs. It also offers states flexibility in expanding the list of preventable conditions and choosing the healthcare settings in which Medicaid may or may not deny payment.

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