Pro­posed rule from CMS would of­fer states op­tions on how to pay re­cov­ery au­dit contractors.

Modern Healthcare - - Contents -

In a pro­posed rule re­gard­ing new Med­i­caid re­cov­ery au­dit contractors, the CMS said states will be al­lowed to de­ter­mine whether to pay their Med­i­caid RACs on a con­tin­gency ba­sis or un­der some other fee struc­ture that iden­ti­fies un­der­pay­ments. This year’s Pa­tient Pro­tec­tion and Af­ford­able Care Act re­quires states to es­tab­lish Med­i­caid RAC pro­grams by sub­mit­ting state plan amend­ments to the CMS by Dec. 31. The pro­posed reg­u­la­tion also high­lights the re­quire­ments that states must meet, and the fed­eral con­tri­bu­tion that CMS will pro­vide to help in fund­ing state RAC pro­grams. Un­der the reg­u­la­tion, a state may use its cur­rent ad­min­is­tra­tive ap­peals process or may change its process for ap­peals re­lated to Med­i­caid RACs. “All fees paid to the Med­i­caid RACs must come from amounts re­cov­ered af­ter all avail­able ap­peals have been ex­hausted,” the agency said in its an­nounce­ment. The rule also pro­poses that states and Med­i­caid RACs co­or­di­nate with other contractors and or­ga­ni­za­tions au­dit­ing Med­i­caid providers and with state and fed­eral law en­force­ment agen­cies.

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