The Centers for Medicare & Medicaid Services yesterday issued a final rule updating the Payment Error Rate Measurement and Medicaid Eligibility Quality Control programs to reflect how states adjudicate eligibility for Medicaid and the Children’s Health Insurance Program under the Affordable Care Act, among other changes. Under the rule, which takes effect 30 days after publication in the July 5 Federal Register, CMS will resume the eligibility measurement component of the PERM program July 5 for reporting in 2019. The program will review state Medicaid and CHIP payments through June of a given year, and a federal contractor will conduct PERM eligibility reviews for each state. The program will conduct eligibility reviews on a sample of fee for service and managed care payments and the beneficiaries associated with the sampled claims. Improper payments will be cited if the federal share amount is incorrect, with potential payment reductions or disallowances in cases where the state’s improper payment rate exceeds the 3% threshold. Under changes to the MEQC program, states must submit corrective actions for identified errors, and CMS will provide direction for active case reviews if a state has consecutive improper payment rates that exceed the 3% threshold. For more on the final rule, see the CMS factsheet.

Related News Articles

Headline
The Senate Appropriations Committee July 31 advanced the fiscal year 2026 appropriations bill for the Departments of Labor, Health and Human Services,…
Perspective
House members are back in their districts for the August recess and senators are likely to return to their states soon.While lawmakers are home, it’s important…
Headline
The Joint Commission July 29 announced an initiative to address “gaps” in how children’s hospitals are accredited and certified. The program will remove or…
Headline
Five pediatric flu deaths were reported to the Centers for Disease Control and Prevention last week, pushing the total to 266 for the 2024-2025 flu season,…
Chairperson's File
Public
The recently enacted One Big Beautiful Bill Act will bring big changes to health care. AHA President and CEO Rick Pollack joined me for a Leadership Dialogue…
Headline
The AHA July 24 announced it is collaborating with health care technology leader Epic to help hospitals adopt tools that support the early detection and…