§1396b–1 Payment Adjustment for Health Care-acquired Conditions

Summary

The Health and Human Services Secretary must find state rules that stop payment for medical problems people get while in health care, and use those rules or parts of them to make similar rules for Medicaid. Those Medicaid rules must start on July 1, 2011, and they must stop federal Medicaid payments to states for money spent treating the specific health care-acquired conditions named in the rules. The rules must not cause Medicaid patients to lose access to care or services. Health care-acquired condition: a medical problem diagnosed that can be shown by a secondary diagnosis code under Medicare rules. The Secretary must apply Medicare’s no-payment-attributable rules to Medicaid as appropriate, but may leave out some Medicare-listed conditions when they do not apply to Medicaid beneficiaries.