Dive Brief:
- CMS released a proposed rule Monday that could update the programs that measure Medicaid improper payments and eligibility.
- The rule would implement provisions of the ACA to change how states determine eligibility for Medicaid and the Children’s Health Insurance Program.
- Among the changes would be a policy that improper payments are to be cited if the federal share is incorrect, even if the total computable amount is correct. Currently, improper payments are only cited if the total computable amount is incorrect.
Dive Insight:
The announcement details numerous proposed updates to the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) programs.
The PERM program updates would include a change to the review timeline from the fiscal year (October through September) to July through June, as well as move the responsibility for eligibilty review from states to a federal contractor. Furthermore, corrective action plans and payment reductions could be heightened for states in which the improper payment rate exceeds 3%.
Meanwhile, the proposed changes to the MEQC program aim to restructure it into "a tool that can be used to help states lower their eligibility improper payment rates and into a program that more effectively compliments the PERM program," CMS' announcement stated. Those changes would include turning it into a pilot program that states would be required to conduct during the years they don't participate in the PERM program, to provide continuous oversight of state eligibility determinations for both Medicaid and CHIP.
Comments on the proposed rule are being taken until August 22.