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Medicaid-Audit of Medicaid Eligibility Determinations for States in Cycle 1 of CMS's PERM Review

The Improper Payments Information Act of 2002 requires the heads of Federal agencies to annually review programs they administer to identify programs that may be susceptible to significant improper payments and estimate the amount of improper payments. The Medicaid program has been identified as a program at risk for significant improper payments. CMS developed the Payment Error Rate Measurement (PERM) program to measure improper payments in the Medicaid program. In 2017, CMS published a new final rule implementing changes to PERM and Medicaid Eligibility Quality Control (MEQC) programs. These changes aimed to reduce State burden, improve program integrity, and promote State accountability through policy and operational improvements to the PERM and MEQC programs. PERM produces an improper payment rate based on reviews of the fee-for-service, managed care, and eligibility components of Medicaid. We will assess the adequacy of the PERM program by determining whether the Federal contractor conducted eligibility reviews in accordance with Federal PERM requirements.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
January 2020 Centers for Medicare & Medicaid Services Medicaid-Audit of Medicaid Eligibility Determinations for States in Cycle 1 of CMS's PERM Review Office of Audit Services W-00-20-31540 2020