Common use of Payment for Health Care-Acquired Conditions and Provider-Preventable Conditions Clause in Contracts

Payment for Health Care-Acquired Conditions and Provider-Preventable Conditions. The Contractor shall develop policies and procedures to prohibit the payment of charges for certain hospital acquired conditions and “never events.” These policies and procedures shall be approved by OMPP prior to implementation and upon any subsequent change. In accordance with 42 CFR 434.6(a)(12), 42 CFR 438.3(g) and 42 CFR 447.26, no payment shall be made by the Contractor to a provider for a provider-preventable condition as identified in the State Plan. All payments made by Contractor for “never events” shall be recovered by the Contractor and/or OMPP as prescribed in section 7.4 Program Integrity Overpayment Recovery.