The Centers for Medicare & Medicaid Services announced that it would no longer provide Medicaid reimbursements to hospitals and providers for injuries, illnesses or hospitalizations that could have been prevented. The announcement is in support of a provision within the Affordable Care Act that prohibits states from making payments to providers for "reasonably preventable" conditions.
The list of preventable illnesses and conditions mirrors those in a 2008 regulation for Medicare that also stopped reimbursing providers for specific medical conditions and includes transfusing the wrong blood type; falls that result in dislocation, fractures, or head injuries; burns and electric shocks; catheter-associated urinary tract infections; surgical site infections after bariatric surgery or coronary artery bypass; and manifestations of poor glycemic control.
South Carolina's Medicaid program said it overpaid a medical home company by $10.5 million and is seeking to recover those funds. State Department of Health and Human Services director Tony Keck, said that even though the overpayments were the fault of the state agency it was incumbent upon the provider, Community Health Solutions, to make repayment. Community Health Solutions is contesting the state's claim. At issue is the calculation of payments based on a contract with CHS and its projected savings for Medicaid beneficiaries. The state contends the program didn't save as much as projected which accounted for the overpayments, while CHS contends is using flawed assumptions of pharmacy rebates for its Medicaid program.
Cuts to Medicaid in New Hampshire will cost hospitals $250 million over the next two years, as a result of the budget passed by state legislators. The cuts are the result of the state tapping, for the first time, funds generated by the Medicaid Enhancement Tax (MET), a 5.5 percent tax paid by hospitals that has been used to fund the state's Medicaid program. The budget proposes that $75.9 million of MET revenue will be diverted to state coffers in 2012 and another $81.9 million in 2013. The money generated by the 5.5 percent tax has traditionally been used by the state to pay hospitals for Medicaid patients or for uncompensated care provided by hospitals.