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Audit (A-02-09-01037)

08-06-2010
Review of New York State's Compliance With the Prompt Pay Requirements for the Increased Federal Medical Assistance Percentage Under the American Recovery and Reinvestment Act of 2009

Executive Summary

Our review found that New York State complied with the prompt pay requirement for receiving an increased Federal medical assistance percentage (FMAP) under the American Recovery and Reinvestment Act of 2009 (Recovery Act). Specifically, the State paid 100 percent of the 125,618,625 clean claims that it received from applicable providers within 30 days of the date of receipt.

Pursuant to the Social Security Act, the Federal Government pays its share of a State's medical assistance expenditures under Medicaid based on the FMAP, which varies depending on the State's relative per capita income. For the recession adjustment period (October 1, 2008, through December 31, 2010), the Recovery Act provides an estimated $87 billion in additional Medicaid funding based on temporary increases in States' FMAPs. Federal regulations require State Medicaid agencies to pay 90 percent of all clean claims from practitioners within 30 days of the date of receipt (the prompt pay requirement). A clean claim is a claim that can be processed without obtaining additional information from the provider or a third party.

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