Medicaid Will Deny Payment for Provider-Preventable Conditions

The Division of Medicaid and Health Financing (DMHF) is submitting a change to the Medicaid State Plan (SPA 11-009-UT, Provider-Preventable Conditions).

In addition to Attachment 4.19-A of this State Plan Amendment, which DMHF previously submitted to include provisions for provider-preventable conditions, Attachment 4.19-B is amended to note that Medicaid will not reimburse providers for other provider-preventable conditions that include incorrectly applied surgeries and procedures. The Division is adopting this change in accordance with 42 CFR 447.26.

DMHF anticipates no substantive cost decrease as provider-preventable conditions are generally not billed to the Medicaid program by providers in Utah.

This proposed change, if approved, becomes effective on July 1, 2012. The proposed change is pending Centers for Medicare and Medicaid Services approval.

A copy of the change may be obtained from Craig Devashrayee (801-538-6641), or by writing the Technical Writing Unit, Utah Department of Health, P.O. Box 143102, Salt Lake City, UT 84114-3102. Comments are welcome at the same address. Copies of the change are also available at local county health department offices.

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