The Centers for Medicare & Medicaid Services today announced several new Medicaid program integrity initiatives. Specifically, the agency will begin auditing select states based on the amount spent on clinical services and quality improvement versus administration and profit, including looking at managed care state rate setting and health plan medical loss ratios. In addition, the agency will focus on states at “high-risk" for errors in making Medicaid and Children’s Health Insurance Program eligibility determinations; and on validating the quality and completeness of state-provided claims and provider data. “With historic growth in Medicaid comes an urgent federal responsibility to ensure sound fiscal stewardship and oversight of the program,” said CMS Administrator Seema Verma. “These initiatives are the vital steps necessary to respond to Medicaid’s evolving landscape and fulfill our responsibility to beneficiaries and taxpayers.”

Related News Articles

Headline
The Centers for Medicare…
Headline
AHA said it generally supports CMS’ efforts to grant greater state-level flexibility and reduce regulatory burden, but urged the agency to ensure Medicaid…
Headline
After taking office last week, Maine Gov. Janet Mills signed an executive order directing Maine officials to swiftly begin implementing a November 2017 ballot…
Headline
The Centers for Medicare…
Headline
Medicare and Medicaid underpaid U.S. hospitals by $76.8 billion in 2017, according to the latest data from the AHA's Annual Survey of Hospitals.
Headline
The Centers for Medicare and Medicaid Services today approved a Section 1115 waiver for Michigan that will require able-bodied adults aged 19 to 62 to work or…