The 2010-11 General Appropriations Act (Article IX, Section 17.78, S.B. 1, 81st Legislature, Regular Session, 2009) appropriated funds for claims system modifications to deny payments for preventable adverse events, and requires the Health and Human Services Commission (HHSC) to submit a progress report by November 1, 2010, on the implementation of new rules related to preventing payment for hospital medical errors in the Medicaid program.
Additionally, HHSC adopted rules that require hospitals to submit present on admission indicators pursuant to S.B. 203, 81st Legislature, Regular Session, 2009. HHSC will impose reimbursement denials or reductions for preventable adverse events as defined by Medicare. These rules were effective beginning September 1, 2010. System changes were made to the Medicaid claims system for claims with dates of service on or after September 1, 2010, to comply with the new requirements.
As of September 30, 2010, a total of 10,288 claims have processed with the POA indicator. Of these claims, nine were denied for incorrect POA submission and zero claims have had their payments downgraded or denied for POA.The changes included providing definitions for present on admission (POA) indicator, http://www.hhsc.state.tx.us/reports/2010/Preventable-Adverse-Events2009.pdf