States considering nonpayment policies for preventable adverse conditions will need to decide which conditions to select for nonpayment, how to define those events or conditions, how to handle an event or condition that occurs during a care transition, how and whether to differentiate between events that are "always" or "usually" preventable, how to ensure compliance with reporting, and more generally how to keep the focus on improving the care delivery system rather than assigning blame to providers. Read more »
Nonpayment for adverse events is the focus of Missouri’s payment reform. Its Medicaid program, MO Healthnet, instituted a nonpayment policy for preventable serious adverse events and hospital or ambulatory surgical center–acquired conditions on June 30, 2009. Read more »
The Kansas Medical Assistance Program, the state's Medicaid program, designed its nonpayment policy to mirror Medicare's policy; as of January 2009, Medicaid does not reimburse providers for the CMS list of hospital-acquired conditions. Read more »
In 2003, Minnesota became the first state to require public reporting of "never events" based on the National Quality Forum list of severe reportable events. Read more »
Maryland uses a unique nonpayment methodology that is broader in scope than that in Medicare or any other state. Read more »