CMS Administrator Urges Medicaid Program Integrity

ANCOR is sharing this update by the Centers for Medicare and Medicaid Services (CMS) on a blog post by the Administrator of the agency, Seema Verma, because it is important for our members to understand the priorities of key Medicaid policy-makers. The majority of disability supports in the United States are funded by Medicaid.

As written by CMS:

“On June 25, CMS Administrator Seema Verma wrote a blog post titled ‘Medicaid Program Integrity: A Shared and Urgent Responsibility.’ In the blog, Administrator Verma emphasized the importance of ensuring the integrity of the Medicaid program and highlighted a number of CMS guidance documents and initiatives to achieve those goals. These include: 

• An informational bulletin on eligibility verification and appropriate claiming;
• Issuing disallowances on unallowable claims for federal match;
• Increasing audits in a number of areas, including managed care medical loss ratios (MLRs), the Payment Error Measure Rate (PERM), and the Medicaid Eligibility Quality Control (MEQC) program; and
• Improving the quality and use of data under the Transformed Medicaid Statistical Information System (T-MSIS). “

Below ANCOR notes some future initiatives which Administrator Verma shares in the blog post which could be particularly relevant to our members. However, given the diversity of supports our members offer, we encourage our members to read the whole post to be aware of all the initiatives she discusses – current and future.

• “Additional guidance on the Medicaid Managed Care Final Rule from 2016 to further state implementation and compliance with program integrity safeguards, such as reporting overpayments and possible fraud.”
• “Conduct provider screening on behalf of states for Medicaid-only providers to improve efficiency and coordination across Medicare and Medicaid, reduce state and provider burden, and address one of the biggest sources of error as measured by PERM.”
• “Medicaid provider education through Targeted Probe and Educate—which identifies providers who have high error rates and educates them on billing requirements—to reduce aberrant billing, as well as education provided through Comparative Billing Reports—which show providers their billing patterns compared to their peers.”