The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
One Ashburton Place
Boston, MA  02108








Notice of Agency Action

SUBJECT:	MassHealth:  Updates to Federally Designated Provider 
Preventable Conditions and DPH-Designated Serious Reportable 
Events that are not Provider Preventable Conditions under 
MassHealth

AGENCY:		Massachusetts Executive Office of Health and Human Serivces 	
			(EOHHS), Office of Medicaid

The MassHealth agency has updated the description of provider preventable conditions 
that apply to inpatient and outpatient hospitals and freestanding ambulatory surgery 
centers, consistent with Section 2702 of the Patient Protection and Affordable Care Act 
(Pub. L. 111-148) and corresponding federal regulations at 42 CFR 447.26 governing 
non-payment for provider preventable conditions. In addition, for freestanding 
ambulatory surgery centers and inpatient and outpatient hospitals for which MassHealth 
currently applies nonpayment methods for the occurrence of serious reportable events 
(SREs),  the MassHealth agency has updated the description of Department of Public 
Health-designated SREs that are not provider preventable conditions under MassHealth.  
All changes described here are effective for dates of service on or after October 1, 2012.  
The provider payment methods for provider preventable conditions and DPH-designated 
SREs that are not provider preventable conditions under MassHealth have not changed.  
EOHHS estimates that the updates described here will not impact annual aggregate 
expenditures. 

For further information you may contact Kiki Feldmar at the Executive Office of Health 
and Human Services, Office of Providers and Plans, 100 Hancock Street, 6th Floor, 
Quincy, MA, or by e-mail at kiki.feldmar@state.ma.us.

Statutory Authority:  M.G.L. c. 118G; M.G.L. c. 118E; 42 USC §1396a; 42 USC 
§1396b; M.G.L. c. 111, § 51H

Related Regulations:  42 CFR Parts 447, 438 and 434; 105 CMR 130.332 and 140.308.