Common use of 105 PROVIDER PREVENTABLE CONDITIONS Clause in Contracts

105 PROVIDER PREVENTABLE CONDITIONS. Provider-preventable condition means a condition that meets the definition of a “health care- acquired condition” or an “other provider-preventable condition” as defined in this section. Health care-acquired condition means a condition occurring in any inpatient hospital setting, identified as a HAC in the State plan as described in section 1886(d)(4)(D)(ii) and (iv) of the Social Security Act; other than Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) as related to total knee replacement or hip replacement surgery in pediatric and obstetric patients. Other provider- preventable condition means a condition occurring in any health care setting that meets the following criteria: (1) Is identified in the State plan, (2) Has been found by the State, based upon a review of medical literature by qualified professionals, to be reasonably preventable through the application of procedures supported by evidence-based guidelines, (3) Has a negative consequence for the beneficiary, (4) Is auditable, and (5) Includes, at a minimum, wrong surgical or other invasive procedure performed on a patient; surgical or other invasive procedure performed on the wrong body part; surgical or other invasive procedure performed on the wrong patient. 1. 106 RATE CELL