Medicare 30-Day Readmission Payment Policy Requirements Effective March 1, 2017

Date: 02/01/17

As part of the Affordable Care Act (ACA), Congress mandated that CMS reduce hospital readmissions through certain payment incentives. Section 3025 of the ACA added section 1886(q) to the Social Security Act establishing the Hospital Readmissions Reduction Program, which requires CMS to reduce payments to IPPS hospitals with excess readmissions, effective for discharges beginning on October 1, 2012. The regulations that implement this provision are in subpart I of 42 CFR part 412 (§412.150 through §412.154).           

Similarly, state Medicaid programs are instituting readmission reduction efforts based on the CMS’ initiative, but tailored to meet specific state Medicaid programs. Potentially preventable readmissions to hospitals have long been recognized as a measure of quality of care. Many Medicaid programs and other payers have policies under which they may deny payment for specific readmissions that result from care that was provided in the initial admission. Examples include repeat admissions for asthma or admissions for postoperative bleeding.

MHS Health Wisconsin Medicare Advantage is implementing a 30-Day Readmission Payment Policy to promote more clinically effective, cost-efficient and improved healthcare through appropriate and safe hospital discharge of patients. Policy documents will be posted on the MHS Health Wisconsin Medicare Advantage website at advantage.mhswi.com. The policy will be effective with respect to initial admissions occurring on and after March 1, 2017, and readmissions occurring thereafter that are related to such initial admissions.

If you have questions, call our provider inquiry line at 1-877-935-8024.