Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services

General Notice
Non-Payment for Provider Preventable Conditions
Date Posted: 8/17/2011
Expiration Date: 9/19/2011
Submitted to Registrar for publication: YES
No comment forum defined for this notice.



(pursuant to §1902(a)(13) of the Act (U.S.C. 1396a(a)(13))




The Virginia Department of Medical Assistance Services (DMAS) hereby affords the public notice of its intention to amend the Virginia State Plan for Medical Assistance to provide for changes to payment for provider-preventable conditions, including health care acquired conditions, as required by Section 2702 of the Affordable Care Act and the implementing federal rule published on June 6, 2011.


DMAS intends to adopt the minimum requirements under the federal rule (FR 76:108, 6/6/2011, p 32816) prohibiting payment for health care acquired conditions in inpatient hospital settings and the following other provider-preventable conditions occurring in any health care setting:  (i) wrong surgical or other invasive procedure performed on a patient; (ii) surgical or other invasive procedure performed on the wrong body part; (iii) surgical or other invasive procedure performed on the wrong patient.  DMAS expects only a minimal reduction in annual aggregate expenditures and has therefore not estimated a fiscal impact.  The agency is making changes required by the federal rule to protect Medicaid beneficiaries and the Medicaid program by prohibiting payments for services related to provider-preventable conditions.  Comments can be mailed to or copies of proposed changes can be requested from Carla Russell, Department of Medical Assistance Services, 600 East Broad Street, Richmond, VA 23219. 



Contact Information
Name / Title: Brian McCormick  / Regulatory Supervisor
Address: 600 E. Broad St., Suite 1300
Richmond, 23219
Email Address:
Telephone: (804)371-8856    FAX: (804)786-1680    TDD: (800)343-0634