CMS establishes state pilot programs to determine accuracy in Medicaid eligibility
Tuesday, September 3, 2013
by: Policy Team

Section: Quality and Educational Programming




  In a letter to State Medicaid Directors on Aug. 15, the Centers for Medicare and Medicaid Services (CMS) provided guidance to states on the Payment Error Rate Measurement (PERM) and the Medicaid Eligibility Quality Control (MEQC) programs. 
 
PERM reviews are conducted every three years to determine the error rates within Medicaid and CHIP.  PERM reviews include results from fee-for-service and managed care payments, in addition to conclusions from the state eligibility review.  MEQC reviews happen yearly and can include pilot projects. 
CMS will run Medicaid and CHIP Eligibility Review Pilots in all states in place of both PERM and MEQC due to changes in Medicaid eligibility and system changes put in place by the Affordable Care Act.  CMS will be implementing an annual 50-state pilot program strategy starting January 1, 2014, for fiscal years (FY) 2014 - 2016. 

The pilots aim to deliver individual evaluations of the performance of the new procedures and systems that determine eligibility for each individual state, evaluate operations and systems that lead to errors, and examine how states amend eligibility problems.

Click here to read a letter to state Medicaid Directors addressing this issue. http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-13-005.pdf
 
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