Monday, February 13, 2012

90 PERCENT FFP - CONDITIONS

The Medicaid provisions of the final rule for Conditions States Must Meet to Receive 90 Percent FFP and Financial Oversight/Combating Fraud and Abuse


Conditions States Must Meet to Receive 90 Percent FFP
The final rule:

  • Specifies the prior approval conditions that must be met in order to receive FFP for reasonable administrative expenses;

  • Establishes the Health Information Technology Advance Planning and Implementation Documents  and the requirements for requesting FFP and for the content of the   State Medicaid Health Information Technology (HIT) Plans, which describe how States plan to implement their Medicaid EHR Incentive programs..

Financial Oversight/Combating Fraud and Abuse

 The final rule:

  • Provides that the states will fight fraud and abuse, including ensuring that there shall be no duplication of payment between the Medicare and Medicaid programs as a requirement of the State Medicaid HIT Plan;
  • Requires that there will be recoupment of monies if overpayments or erroneous payments are found to have been paid;

  • Requires a provider appeals process for eligibility, payments, and determinations of meaningful use as a requirement of the State Medicaid HIT Plan;

  • Reiterates CMS’ process for financial oversight of the Medicaid Budget and Expenditure System.

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