Statute

On February 8, 2006, the President signed the Deficit Reduction Act (DRA) of 2005.  Section 5001(c) of DRA requires the Secretary to identify conditions that are:  (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines.  Section 5001(c) provides that CMS can revise the list of conditions from time to time, as long as it contains at least two conditions.  DRA Section 5001(c) is available in the Downloads section below.

Regulations

On April 14, 2008, the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Proposed Rule display copy was posted to the CMS web site.  To view the IPPS FY 2009 Proposed Rule, see the Related Links Inside CMS section below.

The IPPS FY 2009 Proposed Rule presents 9 candidate conditions for consideration and proposes an approach for applying the Present on Admission (POA) Indicator reporting options to Medicare payment for the selected conditions.

CMS created a press released and fact sheets addressing the IPPS FY 2009 Proposed Rule content.  To view these materials, see the Related Links Inside CMS section below.

In the IPPS FY 2008 final rule, CMS selected 8 conditions that met the statutory selection criteria.  The IPPS FY 2008 Final Rule is available in the Related Links Outside CMS section below. 

Payment implications will begin October 1, 2008, for these 8 conditions and any of the 9 candidate conditions that are selected in the IPPS FY 2009 final rule.

You are encouraged to submit comments regarding the HAC section of the IPPS FY 2009 Proposed Rule.  The comment period ends June 13, 2008.  Instructions for submitting comments are available in the Related Links Inside CMS section below.

Program Instructions

On July 20, 2007, Change Request (CR) 5679 – Present on Admission Indicator was released.  This CR instructs on correct POA Indicator reporting options.  The CR is available in the Related Links Inside CMS section below.

Downloads
Deficit Reduction Act of 2005 Section 5001 (c) [PDF 85KB]
Related Links Inside CMS
Instructions for Submitting Comments - Instructions begin on page 3 IPPS FY 2009 Proposed Rule Press Release IPPS FY 2009 Proposed Rule HAC Fact Sheet IPPS FY 2009 Proposed Rule HAC and Never Events Fact Sheet Change Request 5679
Related Links Outside CMS
IPPS FY 2009 Proposed Rule (Instructions for submitting comments begins on page 23528; HAC Section begins on page 23547) IPPS FY 2008 Final Rule (HAC Section begins on page 72)

Page Last Modified: 05/16/2008 7:27:14 AM
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