Payments for Provider-Preventable Conditions. Section 2702(a) of the Affordable Care Act (ACA) prohibits federal financial participation (FFP) payments to States for any amounts expended for providing medical assistance for Provider Preventable Conditions (PPCs), including health care-acquired conditions (HCACs) and other provider-preventable conditions (OPPCs). PPCs are hospital-acquired conditions not present on hospital admission, the wrong procedure performed on a patient, and procedures performed on a wrong patient or body part. The MCO may not make payments for PPCs as defined by the federal regulations and DHHR policy in accordance with 42 CFR §438.6 and 42 CFR §447.26. The MCO will track PPC data and make it available to DHHR upon request. (i) Is identified in the State plan. (ii) Has been found by the State, based upon a review of medical literature by qualified professionals, to be reasonably preventable through the application of procedures supported by evidence-based guidelines. (iii) Has a negative consequence for the beneficiary. (iv) Is auditable. (v) Includes, at a minimum, wrong surgical or other invasive procedure performed on
Appears in 5 contracts
Samples: Purchase of Service Provider Agreement, Purchase of Service Provider Agreement, Purchase of Service Provider Agreement
