Hospital Acquired Conditions and Serious Adverse Events

On October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) stopped paying hospitals for costs incurred when a patient developed any of ten Hospital Acquired Conditions (HAC). On January 1, 2009, CMS further issued a national coverage determination to stop paying for certain serious adverse events: surgeries on the wrong site, surgery on the wrong patient and the wrong surgery. In September 2009, the state of New Jersey passed bill S 2471 which required hospitals and health care providers to stop billing for “Hospital Acquired Conditions” or any other conditions for which payment was not allowed by CMS.

Horizon NJ Health complies with the state and federal regulations regarding no payment for these HACs or any other conditions for which payment is not allowed by CMS. The Quality Management department investigates all quality of care referrals, including HACs and serious adverse events, to identify compliance with standards of care and evidence based practice. When opportunities for quality improvement exist, this is communicated with the involved hospital or provider to assist them with their internal quality improvement process. For more information, please refer to the Hospital Acquired Conditions No Payment Policy located in the Medical Policies section of this Web site or call the Horizon NJ Health Quality Department at 1-800-682-9094.