MEMORANDUM

DISCUSSION:

States are responsible for measuring improper payments based on eligibility decisions for both MO HealthNet and Children's Health Insurance Programs (CHIP) and reporting the findings to Centers for Medicare and Medicaid Services (CMS). The name of this process is Payment Error Rate Measurement (PERM) and is similar to Food Stamp Quality Control (QC) reviews.

PERM reviews are completed in 3 year cycles.  Missouri’s last review was Federal Fiscal Year 2009.  As a result, our next review will be FFY2012 which is October 1, 2011 through September 30, 2012.  During this cycle, the reviews will be completed by the Quality Control Unit staff.

Cases are selected randomly for review each month. QC Office Support Assistant (OSA) staff request the case files from the local FSD office. The local office must forward the entire case record, including the Food Stamp section, to the appropriate OSA within five days of receiving the request. QC staff will copy the file and return the original file to the local office.

Below is a guide to assist staff with case requests:

• For active MO HealthNet for Families (MHF), MO HealthNet for Kids (MHK), and MO HealthNet for Pregnant Women (MPW) programs, provide information for the previous two years and the vital statistics information;
• For active adult programs such as MO HealthNet for the Aged, Blind, and Disabled (MHABD), provide information for the previous five years and the vital statistics information; and
• For closings/rejections, provide information for the previous year and the vital statistics information.

If contacted by participants with questions, Eligibility Specialists should explain the basics of PERM and encourage the participant to cooperate with Quality Control Unit staff.

NECESSARY ACTION:

• Review this memorandum with all appropriate staff.
• Provide complete case record within five days of request.
• Cooperate with staff from Quality Control Unit.

KSO/SH