CMS issues rule to strengthen fiscal integrity of Medicaid

CMS issued the proposed Medicaid Fiscal Accountability Rule Nov. 12, which establishes new reporting requirements for state supplemental payments to Medicaid providers.

Supplemental payments

States currently provide CMS with aggregate payment detail for base and supplemental payments to Medicaid providers. The proposal would require them to supply provider-level payment detail to support the aggregate information received through Upper Payment Level demonstrations. 

The reporting of such data "will aid with transparency within the Medicaid program as well as support both states and CMS in better oversight of the program," said CMS.

Under the proposal, states would also be required to identify the authority for payments received for state plan services and through demonstration programs (i.e. state plan amendment or demonstration), as well as where the nonfederal share for these payments came from.  

Financing definitions

As far as Medicaid financing definitions, CMS has proposed new regulatory ones for Medicaid "base" and "supplemental" payments. These payments are not currently defined.

Provider ownership

The proposal would also clarify definitions and processes linked to provider ownership categories, partially to prevent states from trying to inappropriately fund their share of Medicaid costs, according to CMS.

Tax waivers

Under the proposal, states would also be required to sunset supplemental payments and tax waivers after no longer than three years, with a renewal option. CMS said this is "to ensure payment arrangements align with both state and federal Medicaid program goals."

The proposed rule will be published in the Federal Register for public review and comment for 60 days.

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