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Payment Policy for a Preventable Serious Adverse Event or Hospital or Ambulatory Surgical Center-Acquired Condition - Mo. Code Regs. Ann. tit. 15, § 70-15.200

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The state of Missouri has the right to deny payment or recover payments made to Missouri Healthnet (Missouri Medicaid program) participating hospitals or ambulatory surgical centers for treatments as a result of a serious adverse event if the serious adverse event was:

  1. Preventable;
  2. Within the control of the hospital or ambulatory surgical center;
  3. Occurred during a hospital admission, hospital surgery care, or in the care of an ambulatory surgical center;
  4. Resulted in serious harm;
  5. Included in the National Quality Forum’s list of serious reportable events as of December 15, 2008, or in the Centers for Medicare and Medicaid Services’ list of Medicare Hospital Acquired Conditions as of December 15, 2008. 

The law also states that a Medicaid recipient is not liable for payment for services received as a result of a serious adverse event that would have been payable by Missouri’s Medicaid program. 

Furthermore, Medicaid participating hospitals and ambulatory surgical centers are required to participate with a patient safety organization, and report all occurrences of serious adverse events and root cause analysis to the patient safety organization.

Current as of June 2015