42 U.S. Code § 1396b–1 - Payment adjustment for health care-acquired conditions

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(a) In general
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.
(b) Health care-acquired condition
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)).
(c) Medicare provisions
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.


[1]  So in original. The period probably should be a comma.

Source

(Pub. L. 111–148, title II, § 2702,Mar. 23, 2010, 124 Stat. 318.)
References in Text

The Social Security Act, referred to in subsec. (c), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XIX of the Act is classified generally to this subchapter. Title XVIII of the Act is classified generally to subchapter XVIII (§ 1395 et seq.) of this chapter. For complete classification of this Act to the Code, see section 1305 of this title and Tables.
Codification

Section was enacted as part of the Patient Protection and Affordable Care Act, and not as part of the Social Security Act which comprises this chapter.

This is a list of parts within the Code of Federal Regulations for which this US Code section provides rulemaking authority.

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42 CFR - Public Health

42 CFR Part 435 - ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA

42 CFR Part 436 - ELIGIBILITY IN GUAM, PUERTO RICO, AND THE VIRGIN ISLANDS

42 CFR Part 447 - PAYMENTS FOR SERVICES

42 CFR Part 456 - UTILIZATION CONTROL

42 CFR Part 482 - CONDITIONS OF PARTICIPATION FOR HOSPITALS

42 CFR Part 1002 - PROGRAM INTEGRITY—STATE-INITIATED EXCLUSIONS FROM MEDICAID

42 CFR Part 1003 - CIVIL MONEY PENALTIES, ASSESSMENTS AND EXCLUSIONS

42 CFR Part 1007 - STATE MEDICAID FRAUD CONTROL UNITS

45 CFR - Public Welfare

45 CFR Part 302 - STATE PLAN REQUIREMENTS

45 CFR Part 303 - STANDARDS FOR PROGRAM OPERATIONS

45 CFR Part 304 - FEDERAL FINANCIAL PARTICIPATION

45 CFR Part 307 - COMPUTERIZED SUPPORT ENFORCEMENT SYSTEMS

 

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