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Medicaid program; reductions in payments to the states--Health Care Financing Administration. Interim final rule with
Abstract:
This rule amends current Medicaid regulations to implement section 2161 of the Omnibus Budget Reconciliation Act of 1981 (Pub. L 97-35) which imposes reductions in Federal matching payments for fiscal years 1982 through 1984. In the regulations, we describe the conditions and specify minimum criteria under which States may lower the reduction. The conditions are the existence of the qualified hospital cost review program, a specific level of unemployment in a State, and a specific amount of fraud and abuse recoveries by a State or, for fiscal year 1982 only, a combination of fraud and abuse and third party liability recoveries. We intend these regulations to provide guidance as to when the reductions, and offsets against the reductions, will be made and how States can qualify for the offsets. In addition, we have issued a notice of proposed rulemaking elsewhere in this issue of the Federal Register that contains proposed policies concerning recoveries from liable third parties for purposes of implementing section 2161.
Insights
New Medicaid regulations implement federal payment reductions for fiscal years 1982-1984. States can qualify for offsets by meeting criteria like hospital cost review programs or fraud recoveries.
Area of Science:
- Health Policy
- Government Regulation
- Public Finance
Background:
- Federal matching payments for Medicaid are subject to reductions under the Omnibus Budget Reconciliation Act of 1981.
- The act imposes payment reductions for fiscal years 1982 through 1984.
Purpose of the Study:
- To amend current Medicaid regulations to implement Section 2161 of the Omnibus Budget Reconciliation Act of 1981.
- To outline conditions and minimum criteria for states to lower federal payment reductions.
- To provide guidance on offsets against reductions and state qualification for these offsets.
Main Methods:
- Amending existing Medicaid regulations.
- Specifying conditions for reduction offsets, including qualified hospital cost review programs.
- Defining criteria for unemployment levels and fraud/abuse/third-party liability recoveries.
Main Results:
- Establishes conditions under which states can lower federal payment reductions.
- Outlines criteria for fraud and abuse recoveries, and third-party liability recoveries for fiscal year 1982.
- Provides a framework for states to qualify for offsets against payment reductions.
Conclusions:
- The regulations provide clear guidance on implementing federal payment reductions and associated offsets.
- States must meet specific programmatic and financial criteria to mitigate payment reductions.
- Further proposed rulemaking addresses policies for third-party liability recoveries.