Review of Medicaid Management Information System Prepayment Edit in the District of Columbia

摘要

The Districts Federal medical assistance percentage (FMAP) is 70 percent. The Department of Health & Human Services (HHS) advances funds equal to the Federal share of the estimated cost of the program on a quarterly basis. CMS may require adjustment of the grant award for the Federal share of firmly established overpayments to providers. Improper payments to providers are not medical assistance under the State plan within the meaning of sections 1903(a)(1) and 1905(a) of the Act. Therefore, Federal funding in such payments constitutes an overpayment which must be adjusted under section 1903(d)(2)(A). Accordingly, after reviewing the States form CMS-64, Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program, the Secretary may adjust future payments to reflect any overpayment or underpayment that the State made in prior quarters. Our objective was to determine whether the State agencys MMIS edit 103 properly prevented overpayments for conflicts.