Medicaid program; federal funding for Medicaid eligibility determination and enrollment activities. Final rule

Area of Science:

• Health Policy
• Information Systems
• Public Health Administration

Background:

• Medicaid regulations govern claims processing and information retrieval systems.
• Federal financial participation (FFP) incentivizes system improvements.
• Previous regulations did not fully address system performance standards.

Purpose of the Study:

• To revise Medicaid regulations for Mechanized Claims Processing and Information Retrieval Systems.
• To extend the availability of enhanced FFP for eligibility determination systems.
• To establish performance standards for enhanced FFP eligibility.

Main Methods:

• Final rule publication.
• Modification of existing Medicaid regulations.
• Imposition of defined standards for system timeliness, accuracy, efficiency, and integrity.

Main Results:

• Revised Medicaid regulations for Mechanized Claims Processing and Information Retrieval Systems.
• Extended enhanced FFP for eligibility determination system design, development, installation, or enhancement until December 31, 2015.
• Established specific standards for system performance to qualify for enhanced FFP.

Conclusions:

• The final rule aims to improve the efficiency and integrity of Medicaid systems.
• Enhanced FFP will continue to support the development of better eligibility determination systems.
• New standards ensure that systems receiving enhanced FFP meet defined performance metrics.