MMA HMO MMA Capitated PSN MMA Specialty Plan MMA CMS Plan REPORT PURPOSE: The purpose of this report is to document Managed Care Plan reporting of instances of as required by the Medicaid and CHIP Managed Care Final Rule (CMS-2390-F) (Final Rule). 42 CFR 438.608(a)(7) requires the Managed Care Plan to report waste to the state Medicaid program integrity unit. Notwithstanding any other provision of law, failure to comply with these reporting requirements will be subject to sanctions. FREQUENCY & DUE The suspected/confirmed waste report is due quarterly, within fifteen (15) calendar days after the end of the quarter being reported. SUBMISSION: To comply with the Suspected/Confirmed Waste Reporting requirements, the Managed Care Plan must submit the following via the MPI SFTP site: The template provided with all required fields completed. The report attestation as described in Chapter 2. INSTRUCTIONS: The Managed Care Plan must report suspected or confirmed instances of waste relative to the Managed Care Plan’s contract and Florida Medicaid. All suspected or confirmed instances of waste under state and/or federal law are to be reported to MPI. In the template provided, on the tab of Waste” the Managed Care Plan “Summary should provide the following information relative to the quarter’s activities in waste recoveries: The reporting period for the report is being submitted; The Medicaid Health Plan name for which the report is being submitted; The Medicaid Health Plan Medicaid ID or IDs for which the report is being submitted; A summary, by quarter, of the instances of suspected/confirmed identified relative by the Managed Care Plan, broken into categories as provided on the template; A summary, by quarter, of the overpayment recoveries made relative to waste by the Managed Care Plan broken, into categories as provided on the template.
MMA HMO MMA Capitated PSN MMA Specialty Plan MMA CMS Plan REPORT PURPOSE: The purpose of this report is to document Managed Care Plan reporting of instances of as required by the Medicaid and CHIP Managed Care Final Rule (CMS-2390-F) (Final Rule). 42 CFR 438.608(a)(7) requires the Managed Care Plan to report waste to the state Medicaid program integrity unit. Notwithstanding any other provision of law, failure to comply with these reporting requirements will be subject to sanctions. FREQUENCY & DUE The suspected/confirmed waste report is due quarterly, within fifteen (15) calendar days after the end of the quarter being reported. SUBMISSION: To comply with the Suspected/Confirmed Waste Reporting requirements, the Managed Care Plan must submit the following via the MPI SFTP site: The template provided with all required fields completed. The report attestation as described in Chapter 2. INSTRUCTIONS: The Managed Care Plan must report suspected or confirmed instances of waste relative to the Managed Care Plan’s contract and Florida Medicaid. All suspected or confirmed instances of waste under state and/or federal law are to be reported to MPI. In the template provided, on the tab “Summary of Waste” the Managed Care Plan should provide the following information relative to the quarter’s activities in waste recoveries: The reporting period for the report is being submitted; The Medicaid Health Plan name for which the report is being submitted; The Medicaid Health Plan Medicaid ID or IDs for which the report is being submitted; A summary, by quarter, of the instances of suspected/confirmed identified relative by the Managed Care Plan, broken into categories as provided on the template; A summary, by quarter, of the overpayment recoveries made relative to waste by the Managed Care Plan broken, into categories as provided on the template.
SMMC_Report_Guide_effective_04012018.docx