CMS’s oversight of State-submitted Medicaid MLR data has limitations due to reliance on optional data elements and lack of internal communication; while CMS has taken steps such as releasing an MLR Toolkit, implementing a web-based submission portal, and making MLR data public…
CMS did not provide adequate oversight of State survey agencies’ use of contract surveyors to conduct nursing home surveys, increasing the risk that Federal requirements are not consistently met.
While the audit identified areas for improvement in reporting consistency and oversight, Arizona’s Medicaid Managed Care Plans demonstrated MLR performance above the federal minimum threshold during the audit period. Implementing the recommendations will improve data integrity…
CMS identified eight findings requiring correction, but none resulted in an MLR recalculation below the 85% remittance threshold; the audit identified operational improvements and oversight enhancements to ensure compliance with federal MLR requirements.
While no remittances were required based on the findings, the audit identified multiple areas for improvement in Ohio’s oversight and reporting processes to ensure compliance with federal requirements and enhance program integrity.
CMS supports Oklahoma’s efforts and encourages further improvements in program integrity. The review identified four observations for the state’s attention but no non-compliance findings that pose a risk.
The audit found that Kansas generally complies with eligibility determination requirements but identified significant areas for improvement, especially in documentation, timely case closure, and resource verification. The improper payments highlight the need for enhanced overs…
The audit identified areas for improvement in Oregon's Medicaid managed care MLR reporting and oversight processes. While no immediate remittance was required, implementing the recommendations will enhance compliance, accuracy, and program integrity.