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Section 2702 of the Patient Protection and Affordable Care Act reduces or prohibits payments to health care providers for Medicaid services rendered as a result of certain preventable health care acquired illnesses or injuries. AHCCCS providers will be required to comply with these federal provisions
beginning July 1, 2012. AHCCCS and its contracted Managed Care
Organizations will review and process medical claims utilizing the list
of provider preventable conditions and surgical errors.
The Centers for Medicare and Medicaid Services (CMS) issued a final rule implementing Section 2702
which reduces or prohibits payments related to provider preventable conditions. This rule builds on Medicare strategies that already reduce or prohibit hospital payments for preventable conditions, and also improves alignment between Medicare and Medicaid payment policies. Although the new rule gives States the flexibility to expand the list of preventable conditions that are not reimbursable, at this time Arizona will employ the list described by the Medicare National Coverage Determinations: surgery on the wrong patient, wrong surgery on a patient, and wrong site surgery.
A Provider-Preventable Condition (PPC) may be either of the following:
Health Care Acquired Condition (HCAC)
Other Provider-Preventable Condition (OPPC)
Additional questions regarding HCAC may be directed to the following