CMS Issues Final Rule on Medicaid Eligibility Quality Control and Payment Error Rate Measurement - Aug. 24, 2010

On Aug. 11, the Centers for Medicare & Medicaid Services issued a final rule implementing changes to the Medicaid Eligibility Quality Control and Payment Error Rate Measurement (PERM) Programs, as required by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). Most significantly, the final rule modified an earlier proposal to the PERM program that would have imposed greater barriers on use of self-declaration of income, which many states use to determine eligibility for Medicaid and CHIP. Under the proposed rule, eligibility determination standards used by many states would not have met the standards for PERM, potentially slowing or blocking access to Medicaid and CHIP for enrollees. Now CMS has loosened its rules, stating that new self-declaration statements will not be required when they already exist in case records, unless such statements are over a year old. CMS also stated that it will soon provide additional guidelines on which eligibility tools meet PERM requirements.