Evidence record
The Centers for Medicare & Medicaid Services’ Eligibility Review Contractor Adequately Determined Medicaid Eligibility for Selected States Under the Payment Error Rate Measurement Program
- Jurisdiction
- ConnecticutPennsylvaniaVirginia
- Publication date
- March 2022
- Source record
- Original document linked
Findings
3
Recommendations
0
No formal recommendations were issued in this record.
Overall conclusion
We determined that CMS’s eligibility review contractor correctly determined Medicaid eligibility for the beneficiaries associated with all 100 sampled claims. Based on our sample results, CMS’s eligibility review contractor adequately determined Medicaid eligibility for three States (Connecticut, Pennsylvania, and Virginia) under CMS’s PERM program in accordance with Federal and State requirements. Accordingly, this report contains no recommendations.
Scope
Audit covered 1,311 Medicaid claims totaling $3,372,346 ($1,936,385 Federal share) included in the eligibility review component of the CMS PERM program for three Cycle 1 States—Connecticut, Pennsylvania, and Virginia. The States were judgmentally selected based on total Medicaid payments, individual State eligibility error rates, and the types of eligibility errors identified by CMS’s eligibility review contractor. A random sample of 100 Medicaid claims (total) for the 3 States totaling $277,748 ($149,628 Federal share) was reviewed. The audit work was conducted from April 2020 through November 2021. The objective was to assess the adequacy of the PERM program by determining whether CMS’s contractor conducted eligibility reviews for selected States in accordance with Federal and State requirements. The PERM program uses a 3-year rotational cycle to produce and report the Medicaid improper payment rate, with Cycle 1 covering the 2017-2018 payments year (RY 2019) and including Connecticut, Pennsylvania, Virginia among others. The three States for this audit were Connecticut, Pennsylvania, and Virginia.
Findings (3)
Each finding has a stable link.
- F-765
Based on the sample results, CMS’s eligibility review contractor adequately determined Medicaid eligibility for three States (Connecticut, Pennsylvania, and Virginia) under the PERM program in accordance with Federal and State requirements.
- F-766
The report contains no recommendations.
- F-764
CMS’s eligibility review contractor correctly determined Medicaid eligibility for the beneficiaries associated with all 100 sampled claims.
Recommendations (0)
This record contains no formal recommendations.