INARF
​​Home | login | contact us
  • About Us
    • About Us
    • Board of Directors
    • Staff
    • Corporate Committees
    • Professional Interest Sections
    • Awards & Recognition
  • Membership
    • Member Login
    • Membership
    • Member Benefits & Inquiries
    • Organizational Member Directory
    • Associate Member Directory
    • Member Job Postings
  • Events
    • Upcoming Events
    • INARF 2023 Pre-Conference
  • Professional Development
    • Professional Development
    • INARF DSP Series
    • INARF Leadership Academy
  • Technical Assistance
    • Technical Assistance
    • Resources
  • Governmental Affairs
    • Governmental Affairs
    • INARF PAC
    • Bills Being Watched
    • Statehouse News
    • Take Action Now With VoterVoice!
  • About Us
    • About Us
    • Board of Directors
    • Staff
    • Corporate Committees
    • Professional Interest Sections
    • Awards & Recognition
  • Membership
    • Member Login
    • Membership
    • Member Benefits & Inquiries
    • Organizational Member Directory
    • Associate Member Directory
    • Member Job Postings
  • Events
    • Upcoming Events
    • INARF 2023 Pre-Conference
  • Professional Development
    • Professional Development
    • INARF DSP Series
    • INARF Leadership Academy
  • Technical Assistance
    • Technical Assistance
    • Resources
  • Governmental Affairs
    • Governmental Affairs
    • INARF PAC
    • Bills Being Watched
    • Statehouse News
    • Take Action Now With VoterVoice!

CMS Announces Initiatives to Strengthen Medicaid Program Integrity

6/27/2018

 
CMS released the following announcement on Tuesday, June 26 in regards to initiatives to strengthen Medicaid program integrity.
 
CMS announces initiatives to strengthen Medicaid program integrity
Agency actions will help ensure the sustainability of vital safety net program for all beneficiaries

Today, the Centers for Medicare and Medicaid Services (CMS) announced new and enhanced initiatives designed to improve Medicaid program integrity through greater transparency and accountability, strengthened data, and innovative and robust analytic tools.

“The initiatives released today are essential to help strengthen and preserve the foundation of the program for the millions of Americans who depend on Medicaid’s safety net. With historic growth in Medicaid comes an urgent federal responsibility to ensure sound fiscal stewardship and oversight of the program,” said CMS Administrator Seema Verma. “These initiatives are the vital steps necessary to respond to Medicaid’s evolving landscape and fulfill our responsibility to beneficiaries and taxpayers.”

Recent years have seen a rapid increase in Medicaid spending driven by several factors, including Medicaid expansion, from $456 billion in 2013 to an estimated $576 billion in 2016. Much of this growth came from the program’s federal share that grew from $263 billion to an estimated $363 billion during that period. While the responsibility for proper payments in Medicaid primarily lies with the states, oversight of the Medicaid program requires a partnership. CMS plays a significant role in supporting state efforts to meet high program standards.

Administrator Verma has set forth three pillars to guide CMS’ work in the Medicaid program: Flexibility, Accountability, and Integrity. Emphasizing these, she expanded on the role of CMS saying, “As we give states the flexibility they need to make Medicaid work best in their communities, integrity and oversight must be at the forefront of our role. Beneficiaries depend on Medicaid and CMS is accountable for the program’s long-term viability. As today’s initiatives show, we will use the tools we have to hold states accountable as we work with them to keep Medicaid sound and safeguarded for beneficiaries.”

The initiatives announced today include stronger audit functions, enhanced oversight of state contracts with private insurance companies, increased beneficiary eligibility oversight, and stricter enforcement of state compliance with federal rules.

Important New Initiatives
1. Emphasize program integrity in audits of state claims for federal match funds and medical loss ratios (MLRs). Audits are central to CMS’ partnership with states—not only encouraging compliance but also revealing how to improve integrity at all levels. Under this initiative, CMS will begin auditing some states based on the amount spent on clinical services and quality improvement versus administration and profit. The MLR audits will include reviewing states’ rate setting. Overall, audits will address issues identified by the Government Accountability Office (GAO) and Office of Inspector General (OIG), as well as other behavior previously found harmful to the Medicaid program.

2. Conduct new audits of state beneficiary eligibility determinations. CMS will audit states that have been previously found to be high risk by the OIG to examine how they determine which groups are eligible for Medicaid benefits. These audits will include assessing the effect of Medicaid expansion and its enhanced federal match rate on state eligibility policy. Current regulations will allow CMS to begin to issue potential disallowances to states based on Payment Error Rate Measurement (PERM) program findings in 2022. The PERM program measures improper payments in the Medicaid program and the Children’s Health Insurance Program (CHIP) on a rolling three year cycle and produces national and state-specific improper payment rates.

3. Optimize state-provided claims and provider data: CMS will utilize advanced analytics and other innovative solutions to both improve Medicaid eligibility and payment data and maximize the potential for program integrity purposes. The Trump Administration has made partnering with states a priority. CMS is committed to work closely with states to ensure that the agency and oversight bodies have access to the best, most complete and accurate Medicaid data. For the first time, every state plus Washington, D.C. and Puerto Rico are now submitting enhanced data to CMS. Over the course of the coming months, we will be validating the quality and completeness of the data.

Ongoing Integrity Work
Working with states to ensure Medicaid provides high-quality care for our most vulnerable people is a central part of CMS’ mission. To learn about noteworthy efforts in place to protect Medicaid’s integrity—including provider screening and education, streamlined access to data, and an enhanced Medicaid Scorecard—see https://www.medicaid.gov/state-resource-center/downloads/program-integrity-strategy-factsheet.pdf.

Comments are closed.

    RSS Feed

    Archives

    September 2022
    August 2022
    July 2022
    June 2022
    May 2022
    April 2022
    March 2022
    February 2022
    January 2022
    December 2021
    November 2021
    October 2021
    September 2021
    August 2021
    July 2021
    June 2021
    May 2021
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    November 2020
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    May 2020
    April 2020
    March 2020
    February 2020
    January 2020
    December 2019
    November 2019
    October 2019
    September 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013
    June 2013
    May 2013
    April 2013
    March 2013
    February 2013
    January 2013
    January 2011
    September 2009
    December 2007

© Indiana Association of Rehabilitation Facilities, Inc. (INARF)
    615 North Alabama Street, Suite 410, Indianapolis, IN 46204
    (t) 317-634-4957 / (f) 317-634-3221 / Contact us by email
ANCOR Proud Member Small