Medicaid Program and State Children's Health Insurance Program (SCHIP); Payment Error Rate Measurement
medicaid · Centers for Medicare and Medicaid Services · Rule · Published 2007-08-31 · Effective 2007-10-01 · 72 FR 50490
Document
Document number
07-4240
Federal Register citation
72 FR 50490
CFR reference
42 CFR 431
Type
Rule
Action
Final rule.
Category
medicaid
Sub-agency
Centers for Medicare and Medicaid Services
Publication date
2007-08-31
Effective date
2007-10-01
HHS docket
CMS-6026-F
Abstract
This final rule sets forth the State requirements to provide information to us for purposes of estimating improper payments in Medicaid and SCHIP. The Improper Payments Information Act of 2002 (IPIA) requires heads of Federal agencies to estimate and report to the Congress annually these estimates of improper payments for the programs they oversee, and submit a report on actions the agency is taking to reduce erroneous payments. This final rule responds to the public comments on the August 28, 2006 interim final rule (71 FR 51050) and sets forth State requirements for submitting claims and policies to the CMS Federal contractors for purposes of conducting fee-for-service and managed care reviews. This final rule also sets forth the State requirements for conducting eligibility reviews and estimating case and payment error rates due to errors in eligibility determinations.