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Medicaid program; reduction in error rate tolerance; Medicaid quality control program--HCFA. Final rule

    Federal Register
    |November 7, 1983
    PubMed
    Summary

    New Medicaid regulations will disallow federal funding to states with eligibility error rates above 3%. These changes, effective January 1, 1984, align with the Tax Equity and Fiscal Responsibility Act of 1982.

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    Area of Science:

    • Health Policy
    • Public Health Law
    • Government Regulation

    Background:

    • Current Medicaid regulations govern federal financial participation for state programs.
    • Medicaid quality control systems measure state eligibility payment error rates.
    • The Tax Equity and Fiscal Responsibility Act of 1982 introduced changes to Medicaid regulations.

    Purpose of the Study:

    • To revise Medicaid regulations regarding federal financial participation.
    • To establish new disallowance criteria for states exceeding error rate tolerances.
    • To implement provisions of the Tax Equity and Fiscal Responsibility Act of 1982.

    Main Methods:

    • Establishing a 3-percent tolerance level for Medicaid eligibility payment error rates.
    • Modifying the projection method for anticipated error rates for specific periods.

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  • Implementing new regulations for periods beginning January 1, 1984.

    • Main Results:

    • Federal financial participation will be disallowed to states exceeding the 3-percent error rate tolerance.
    • Current projection methods for error rates apply only to April 1, 1983 - December 31, 1983.
    • New regulations for error rate management are effective from January 1, 1984.

    Conclusions:

    • The revised Medicaid regulations aim to improve program integrity and reduce payment errors.
    • States must adhere to the new error rate standards to maintain federal funding.
    • The changes reflect a legislative mandate to enhance fiscal responsibility in the Medicaid program.