42 U.S.C. § 1396b–1 — Payment adjustment for health care-acquired conditions
submitted 16 years ago by Pub. L. 111-148 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 294 words · no verdicts yet
The Secretary must identify State rules that stop Medicaid from paying for certain “health care-acquired conditions” and put suitable versions of those rules into Medicaid regulations. The rules must stop Federal payments for those conditions without reducing Medicaid beneficiaries’ access to care.
(a) In general. The Secretary* of Health and Human Services must identify current State* practices* that prohibit payment for “health care-acquired conditions.” The Secretary must put the practices, or suitable parts of them, into Medicaid regulations. The regulations must take effect July 1, 2011, and must prohibit payments to States under section 1903 of the Social Security Act for amounts spent on medical assistance* for the conditions named in the regulations. The regulations must make sure that this payment ban does not reduce Medicaid beneficiaries’ access to care or services.
(b) Health care-acquired condition. In this section, “health care-acquired condition” means a medical condition diagnosed in an individual that could be identified by a secondary diagnostic code described in section 1886(d)(4)(D)(iv) of the Social Security Act. This section does not define the quoted term further.
(c) Medicare provisions. In carrying out this section, the Secretary must apply to Medicaid State plans and waivers, as appropriate, the regulations issued under section 1886(d)(4)(D) of the Social Security Act concerning bans on payment based on a secondary diagnosis code. The Secretary may leave out conditions identified under Medicare for nonpayment under Medicaid when the Secretary finds that including those conditions would not apply to Medicaid beneficiaries.
The Secretary* of Health and Human Services (in this subsection referred to as the “Secretary”) shall identify current State* practices* that prohibit payment for health care-acquired conditions and shall incorporate the practices identified, or elements of such practices, which the Secretary determines appropriate for application to the Medicaid program in regulations. Such regulations shall be effective as of July 1, 2011, and shall prohibit payments to States under section 1903 of the Social Security Act [42 U.S.C. 1396b] for any amounts expended for providing medical assistance* for health care-acquired conditions specified in the regulations. The regulations shall ensure that the prohibition on payment for health care-acquired conditions shall not result in a loss of access to care or services for Medicaid beneficiaries.
In this section.1 the term “health care-acquired condition” means a medical condition for which an individual was diagnosed that could be identified by a secondary diagnostic code described in section 1886(d)(4)(D)(iv) of the Social Security Act (42 U.S.C. 1395ww(d)(4)(D)(iv)).
In carrying out this section, the Secretary shall apply to State plans (or waivers) under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] the regulations promulgated pursuant to section 1886(d)(4)(D) of such Act (42 U.S.C. 1395ww(d)(4)(D)) relating to the prohibition of payments based on the presence of a secondary diagnosis code specified by the Secretary in such regulations, as appropriate for the Medicaid program. The Secretary may exclude certain conditions identified under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.] for non-payment under title XIX of such Act when the Secretary finds the inclusion of such conditions to be inapplicable to beneficiaries under title XIX.
Source credit: (Pub. L. 111–148, title II, § 2702, Mar. 23, 2010, 124 Stat. 318.)
- 2010Enacted · Pub. L. 111-148 · 124 Stat. 318
A history note hasn’t been published yet. The record shows enactment by Pub. L. 111-148 on 2010-03-23.
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