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

Chairperson's File
In this episode, I talk with Jeremy Musher, M.D., chief behavioral medical officer at Lifepoint Health and a member of the AHA Committee on Behavioral Health.…
Headline
The House Veterans' Affairs Subcommittee on Oversight and Investigations May 16 held a hearing on ways to further support and protect law enforcement and…
Headline
The AHA and other national health care organizations May 16 sent a letter to Senate and House appropriations leaders requesting $758 million in funding for the…
Headline
Health care organizations can create more inclusive, responsive and effective maternal health initiatives that address the unique challenges Black women…
Headline
In continuing recognition of Mental Health Awareness Month, Azziza Bankole, M.D., writes about the negative effects of social isolation and loneliness and how…
Blog
Black women in the U.S. experience maternal mortality rates at nearly three times that of white women, regardless of income or education level. This…