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OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES

Notice of Changes in Methods and Standards for Medicaid
Payments for Hospitals, Ambulatory Surgical Centers, Physicians, and Limited License Practitioners


In accordance with public notice requirements of 42 CFR 447.205 and Section 1902(a)(13(A) of the Social Security Act, the Indiana Family and Social Services Administration (FSSA), Office of Medicaid Policy and Planning (OMPP) publishes this notice of proposed changes to the reimbursement methodology for Medicaid services provided by enrolled hospitals, ambulatory surgical centers, physicians, and limited license practitioners.

OMPP proposes to modify reimbursement under the Medicaid state plan and state regulations at 405 IAC 1-8-3 and 405 IAC 1-11.5-2 to set forth the following other provider-preventable conditions for nonpayment: wrong surgical or other invasive procedure performed on a patient; surgical or other invasive procedure performed on the wrong body part; surgical or other invasive procedure performed on the wrong patient. These changes are expected to result in an estimated total annual state savings of approximately $700 (the federal share is approximately $500). These changes shall be effective July 1, 2012.

This change in reimbursement is necessary to ensure that payment is not made for other provider-preventable conditions. On June 6, 2011, CMS published a final rule in the Federal Register at 76 FR 32816 requiring that states implement a policy for other provider-preventable conditions no later than July 1, 2012.

A copy of this notice is now on file at the Indiana Government Center South, 402 West Washington Street, Room W451, Indianapolis, Indiana and open for public inspection. Also, a copy of this notice is now available and may be inspected by contacting the local county Division of Family Resources office, except in Marion County, where public inspection may be made at 402 West Washington Street, Room W374, Indianapolis, Indiana.

Anyone who wishes to comment on the proposed changes may submit written comments to: FSSA, Office of Medicaid Policy and Planning, Attention: Penny Lewis, 402 West Washington Street, Room W374, MS-07, Indianapolis, Indiana 46204. Correspondence should be identified in the following manner: COMMENT RE: OTHER PROVIDER-PREVENTABLE CONDITIONS. Written comments received will be made available for public display at the address herein of the OMPP.

Michael A. Gargano
Secretary
Family and Social Services Administration

Posted: 04/18/2012 by Legislative Services Agency

DIN: 20120418-IR-405120186ONA
Composed: Oct 01,2014 9:24:30AM EDT
A PDF version of this document.