DPHSS Advises Medicare Won’t Pay for “Provider Preventable Conditions” Anymore

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Guam – The Director of the Department of Public Health and Social Services, James W. Gillan, has announced that the Centers for Medicare and Medicaid Services (CMS) will not be paying for certian medical expenses anymore.

Those expenses are:

  * Hospital-Acquired Conditions as identified by Medicare other than Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) following total knee replacement or hip replacement surgery in pediatric and obstetric patients.
 

 * Wrong surgical or other invasive procedure performed on a patient; surgical or other invasive procedure performed on the wrong body part; surgical or other invasive procedure performed on the wrong patient.

A release from DPHSS states that the prohibition is in accordance with the Affordable Care Act in its Final Rule will implement section 2702 of the Patient Protection and Affordable Care Act.

That Final Rule directs the Secretary of Health and Human Services to issue Medicaid regulations effective July 1, 2011 “prohibiting Federal payments to States under section 1903 of the Social Security Act for any amounts expended for providing medical assistance for health care acquired conditions specified in the regulation”.

A copy of the State Plan Amendment (SPA) is available for viewing at the Department of Public Health and Social Services/Division of Public Welfare/Bureau of Health Care Financing Office.

Please contact Ma. Theresa Arcangel, Administrator, BHCFA at 735-7282 or 735-7470.

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      PAYMENT ADJUSTMENT FOR PROVIDER PREVENTABLE CONDITIONS 
       

The Director of the Department of Public Health and Social Services, Mr. James W. Gillan, announces today that The Centers for Medicare and Medicaid Services (CMS), HHS, in accordance with the Affordable Care Act in its Final rule will implement section 2702 of the Patient Protection and Affordable Care Act, which directs the Secretary of Health and Human Services to issue Medicaid regulations effective July 1, 2011 “prohibiting Federal payments to States under section 1903 of the Social Security Act for any amounts expended for providing medical assistance for health care acquired conditions specified in the regulation”. These are the following: 

  • Hospital-Acquired Conditions as identified by Medicare other than Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) following total knee replacement or hip replacement surgery in pediatric and obstetric patients. 

 

  • Wrong surgical or other invasive procedure performed on a patient; surgical or other invasive procedure performed on the wrong body part; surgical or other invasive procedure performed on the wrong patient.

 
A copy of the State Plan Amendment (SPA) is available for viewing at the Department of Public Health and Social Services/Division of Public Welfare/Bureau of Health Care Financing Office. Please contact Ma. Theresa Arcangel, Administrator, BHCFA at 735-7282 or 735-7470.