- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- PAYMENT ACCURACY REVIEW OF MO HEALTHNET
DISCUSSION:
Due to the implementation of the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) has directed states to implement MAGI based eligibility reviews for fiscal years 2014-2016. States are responsible for measuring improper payments based on MAGI eligibility decisions for both MO HealthNet and Children's Health Insurance Programs (CHIP). The name of this process is Payment Accuracy Review of MO HealthNet (PARM) and is similar to Food Stamp Quality Control (QC) reviews.
QA/QC cases are selected randomly for review each month. QA/QC Office Support Assistant (OSA) staff request the case files from the FSD office listed in FAMIS. If the case record has been transferred to another office, it is the FSD office's responsibility to forward the case request to the case location office. The case location office must forward the entire case record to the OSA within five days of receiving the request. QC staff will copy the file and return the original file to the case location office.
If contacted by participants with questions, Eligibility Specialists should explain the basics of PARM and encourage the participant to cooperate with Quality Control Unit staff.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Provide complete case record within five days of request.
- Cooperate with staff from Quality Control Unit.
AC/de