The Centers for Medicare & Medicaid Services yesterday issued a updating the Payment Error Rate Measurement and Medicaid Eligibility Quality Control programs to reflect how states adjudicate eligibility for Medicaid and the Children鈥檚 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鈥檚 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 .

Related News Articles

Headline
The departments of Health and Human Services, Labor, and the Treasury have certified two more independent dispute resolution entities, bringing the total鈥
Headline
The Alliance for Innovation on Maternal Health, with support from the Health Resources and Services Administration, will host a five-part learning series鈥
Headline
The latest video in the AHA鈥檚 series 鈥淢edicaid: Real Lives, Real Care鈥 features Jennifer Clowers, regional chief financial officer of Our Lady of the Lake鈥
Perspective
Public
The fate of the Trump administration鈥檚 legislative centerpiece 鈥 the One Big Beautiful Bill Act 鈥 continues to be the focal point in Washington, D.C.After the鈥
Headline
The AHA June 10 released a new video in its series, 鈥淢edicaid: Real Lives, Real Care,鈥 that features Missouri Hospital Association President and CEO Jon鈥
Headline
The White House June 6 issued a memorandum directing the Secretary of the Department of Health and Human Services 鈥渢o take appropriate action to eliminate鈥