Hospital-Acquired Condition Reduction Program (HACRP)
About the Hospital-Acquired Condition Reduction Program
The Hospital-Acquired Condition (HAC) Reduction Program is a Medicare value-based purchasing program that reduces payments to hospitals based on how they perform on measures of hospital-acquired conditions. The program supports the Centers for Medicare & Medicaid Services’ (CMS’) long-standing effort to link Medicare payments to health care quality in the inpatient hospital setting. The HAC Reduction Program encourages hospitals to implement best practices to reduce their rates of hospital-acquired conditions and improve patient safety.
Section 1886(p) of the Social Security Act sets forth the statutory requirements for the HAC Reduction Program, which requires the Secretary of the U.S. Department of Health and Human Services to adjust payments to hospitals that rank in the worst-performing quartile (above the 75th percentile) of all subsection (d) hospitals with respect to measures of hospital-acquired conditions. On an annual basis, CMS evaluates overall hospital performance by calculating a Total HAC Score for each hospital as the equally weighted average of their scores on measures included in the program. Hospitals with a Total HAC Score greater than the 75th percentile of all Total HAC Scores will receive a payment reduction of 1 percent on overall Medicare fee-for-service (FFS) payments.
The HAC Reduction Program includes the following six quality measures:
- One claims-based composite measure of patient safety:
- CMS Patient Safety and Adverse Events Composite (CMS PSI 90)
- Five chart-abstracted or laboratory-identified measures of healthcare-associated infections (HAIs) submitted to the Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network (NHSN):
- Central Line-Associated Bloodstream Infection (CLABSI)
- Catheter-Associated Urinary Tract Infection (CAUTI)
- Colon and Abdominal Hysterectomy Surgical Site Infection (SSI)
- Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia
- Clostridium difficile Infection (CDI)
For more information on HAC Reduction Program quality measures and scoring methodology, refer to the HAC Reduction Program Measures page and the Scoring Methodology page. CMS is required to publicly report hospitals’ performance in the quality reporting programs. Before publicly reporting results, hospitals can review their results and submit questions, as necessary. Refer to the Scoring Calculations Review and Correction Process page for more information.
CMS will report select program information for the HAC Reduction Program on an annual basis on the data catalog on Data.cms.gov.
Important note: The HAC Reduction Program is distinct from the Publicly Reported Deficit Reduction Act Hospital-Acquired Conditions Measures. Section 5001(c) of the Deficit Reduction Act of 2005 requires the Secretary of the Department of Health and Human Services to identify conditions that (1) are high cost, high volume, or both, (2) result in higher claims payments to hospitals because of the presence of the HACs as a secondary diagnosis, and (3) could reasonably have been prevented through the application of evidence-based guidelines. For more information on the Publicly Reported Deficit Reduction Act Hospital-Acquired Condition Measures, refer to the Educational Resources page on CMS’ website.
General Q & A
1. What are the performance periods for the fiscal year 2027 HAC Reduction Program?
The HAC Reduction Program uses a standard two-year performance period for the CMS PSI 90 and CDC’s NHSN HAI measures, advanced by one year every subsequent program year, unless otherwise specified. The fiscal year (FY) 2027 and 2028 HAC Reduction Program performance periods are listed below.
HAC Reduction Program measure performance periods
| Program year (FY) | Performance period for CMS PSI 90 measure | Performance period for CDC's NHSN HAI measuresa |
|---|---|---|
| 2028 | 7/1/24 to 6/30/26 | 1/1/25 to 12/31/26 |
| 2027 | 7/1/23 to 6/30/25 | 1/1/24 to 12/31/25 |
a CDC’s NHSN HAI measures included in the HAC Reduction Program are: Central Line-Associated Bloodstream Infection (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), Colon and Abdominal Hysterectomy Surgical Site Infection (SSI), Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, and Clostridium difficile Infection (CDI).
CDC = Centers for Disease Control and Prevention; CMS = Centers for Medicare & Medicaid Services; CMS PSI 90 = CMS Patient Safety and Adverse Events Composite; HAC = hospital-acquired condition; HAI = healthcare-associated infection; FY = fiscal year; NHSN = National Healthcare Safety Network
2. When will CMS apply the payment reductions for the HAC Reduction Program?
CMS applies the 1-percent payment reduction when hospital claims are paid. The payment reduction for hospitals that rank in the worst-performing quartile (that is, above the 75th percentile) applies to all Medicare FFS Part A discharges in the corresponding FY (October 1 of the prior year through September 30 of the program year). For example, for the FY 2027 program year, the payment reduction applies to all Medicare FFS discharges from October 1, 2026 to September 30, 2027.
3. What types of patients are included in the CMS PSI 90 and CDC’s NHSN HAI measures?
Patients are included in the CMS PSI 90 measure if they meet, at minimum, the following criteria:
- Are aged 18 years and older
- Are enrolled in Medicare FFS but not in Medicare Advantage
- Have been hospitalized for one of the surgical or medical procedures included in the PSI component measures
CMS does not use non-acute inpatient, outpatient (Part B), Medicare Advantage (Part C), or prescription drug (Part D) claims for estimating the CMS PSIs.
For more information, refer to the CMS PSI Fact Sheet and PSI Technical Specifications available on the QualityNet CMS PSI Resources page.
The HAI measures are calculated using data from an all-payer patient population, which is not limited to Medicare FFS patients. Hospitals should follow NHSN reporting guidelines when determining which patients and wards to include in their reporting for HAI measures.
For more information on NHSN reporting guidelines, reference the NHSN website for Acute Care Hospital CMS Requirements.
4. What baseline is used to calculate the SIR for CDC’s NHSN HAI measures, and when will a new baseline be implemented in the HAC Reduction Program?
Since 2016, CDC has used calendar year (CY) 2015 data to determine the baseline used to calculate the standardized infection ratio (SIR) for CDC’s NHSN HAI measures in the HAC Reduction Program. In the FY 2026 IPPS/LTCH PPS final rule (pages 36963–36965), CMS announced that as part of routine measure maintenance, CDC is updating the baseline used to calculate the SIR for CDC’s NHSN HAI measures from CY 2015 data to CY 2022 data.
The 2022 baseline data will affect the HAC Reduction Program beginning with the FY 2028 program year when both years of the two-year performance period, CYs 2025 and 2026, will use the 2022 baseline for CDC’s NHSN HAI measures. CMS will publicly report the FY 2028 HAC Reduction Program measure results on the data catalog on Data.cms.gov in early 2028.
Resources
Spotlight
For FY 2027, the 30-day Scoring Calculations Review and Correction period extends from September 10, 2026, to October 9, 2026.
Visit the General Q&A for fundamental program information.
Support Contact
Submit questions about the HAC Reduction Program to the QualityNet Question and Answer Tool by selecting “Ask a Question” and then selecting “HACRP – Hospital-Acquired Condition Reduction Program” from the list of programs as well as the relevant topic (or subtopic) as appropriate.
You do not need to create an account to submit a question.
For more information on the methodology for a specific measure, please visit the following pages: