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 AHA Oct. 3 responded to the Medicare Payment Advisory Commission’s recent analysis on the financial impacts of Medicare Advantage enrollment growth on…
Headline
Lindsey Fauveau, M.D., medical director of breast surgical oncology at Woman’s Hospital, shares how the hospital’s state-of-the-art mobile unit brings 3D…
Headline
A JAMA study published yesterday analyzed the health characteristics of individuals projected to lose Medicaid coverage due to work requirements included in…
Headline
The Centers for Medicare & Medicaid Services Sept. 30 released guidance to states clarifying its interpretation of a provision that…
Headline
An analysis published Sept. 30 by KFF found that Health Insurance Marketplace enrollees who currently benefit from the enhanced premium tax credits would pay…
Headline
The AHA Sept. 29 sent recommendations to the Department of Health and Human Services and the Centers for Medicare & Medicaid Services to help ensure…