Medicaid program; reductions in payments to the states--Health Care Financing Administration. Interim final rule with comment period

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.