Recoupment of Funds: When payments are made for services not identified on the PCSP: The Medicaid State Agency • will require a recoupment of unauthorized paid claims based upon the Federal Medical Assistance Percentage (FMAP). When the amount of payments made exceed the amount identified on the annual budget: The • Medicaid State Agency will require a recoupment of unauthorized paid claims based upon the Federal Medical Assistance Percentage (FMAP). When payments are made for services based on a coding error: The coding error will be • corrected by withdrawing the submission of the claim and submitting the correct code for payment. The recoupment of funds will proceed as follows: 1. The State Medicaid Agency will complete a Recoupment of Funds Form that indicates the amount of the recoupment and send it to the Operating Agency. 2. The Operating Agency will review the Recoupment of Funds Form and return the signed form to the State Medicaid Agency. 3. Upon receipt of the Recoupment of Funds Form, the State Medicaid Agency will submit the recoupment to Medicaid Operations. 4. Medicaid Operations will reprocess the MMIS claims to reflect the recoupment. 5. Overpayments are returned to the federal government within 60 days of discovery. ii. Remediation Data Aggregation Remediation-related (check Frequency of data Responsible Party aggregation and Data Aggregation each that applies) analysis: and Analysis (check each that (including trend applies) identification) X State Medicaid Agency Weekly X Operating Agency Monthly Sub-State Entity Quarterly Other Annually Specify: Continuously and Ongoing X Other Specify: OA: At a minimum every two years. SMA: At a minimum every five years. Timelines c. When the State does not have all elements of the Quality Improvement Strategy in place, provide timelines to design methods for discovery and remediation related to the assurance of Financial Accountability that are currently non-operational.
Recoupment of Funds: • When payments are made for services not identified on the PCSP: The Medicaid State Agency will require a recoupment of unauthorized paid claims based upon the Federal Medical Assistance Percentage (FMAP). • When the amount of payments made exceed the amount identified on the annual budget: The Medicaid State Agency will require a recoupment of unauthorized paid claims based upon the Federal Medical Assistance Percentage (FMAP). • When payments are made for services based on a coding error: The coding error will be corrected by withdrawing the submission of the claim and submitting the correct code for payment. The recoupment of funds will proceed as follows: 1. The State Medicaid Agency will complete a Recoupment of Funds Form that indicates the amount of the recoupment and send it to the Operating Agency. 2. The Operating Agency will review the Recoupment of Funds Form and return the signed form to the State Medicaid Agency. 3. Upon receipt of the Recoupment of Funds Form, the State Medicaid Agency will submit the recoupment to Medicaid Operations. 4. Medicaid Operations will reprocess the MMIS claims to reflect the recoupment. 5. Overpayments are returned to the federal government within 60 days of discovery. ii. Remediation Data Aggregation Remediation-related Data Aggregation and Analysis (including trend identification) Responsible Party (check each that applies) Frequency of data aggregation and analysis: (check each that applies) X State Medicaid Agency Weekly X Operating Agency Monthly Sub-State Entity Quarterly Other Specify: Annually Continuously and Ongoing X Other Specify: OA: At a minimum every two years. SMA: At a minimum every five years. c. Timelines When the State does not have all elements of the Quality Improvement Strategy in place, provide timelines to design methods for discovery and remediation related to the assurance of Financial Accountability that are currently non-operational.
ABI%20Waiver%20Amendment%20-%20Final%20Draft%20for%20Public%20Comment.docx