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APA WF# 24-10 Non-Payment of Provider Preventable Conditions

These rule changes are currently in effect as Emergency Rules and must be promulgated as Permanent Rules.

These revisions align agency rules with the Centers for Medicare and Medicaid Services (CMS) final rule regarding Section 2702 of the Affordable Care Act, which reduces or prohibits payments related to provider preventable conditions (PPCs). PPCs include Health Care-Acquired Conditions (HCACs) which apply to any inpatient hospitals settings and Other-Provider Preventable Conditions (OPPCs) which apply to any health care setting. The Agency’s list of PPCs for non-payment will align with the PPCs as identified by Medicare with exceptions for pediatric and obstetric patients for Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) following total knee replacement or hip replacement surgery. In aligning with Medicare, two additional OPPCs for Surgical Site infection following cardiac implantable electronic device (CIED) and Iatrogenic pneumothorax with venous catheterization.

Please view the circulation document here: APA WF # 24-10 and submit feedback via the comment box.

Circulation Date: 12/2/2024

Comment Due Date: 1/6/2025

Public Hearing: 1/6/2025

Board Meeting: 1/15/2025

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After you submit your comment, you should be re-directed to a confirmation page. If you are not, please submit your comment through e-mail to federal.authorities@okhca.org.

Please note that all comments must be reviewed and approved prior to posting. Approved comments will be posted Monday through Friday between the hours of 7:30 a.m. – 4 p.m. Any comments received after 4 p.m. will be posted on the following business day.


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Last Modified on Dec 01, 2024