On Dec. 4, the Centers for Medicare & Medicaid Services (CMS) released an interim final rule titled “Medicaid: Enforcement of State Compliance With Reporting and Federal Medicaid Renewal Requirements Under the Social Security Act.” This rule is aimed at creating new enforcement authorities to be used if states fail to meet reporting requirements or follow Medicaid eligibility redetermination requirements during the timeframe allowed following the end of Medicaid continuous enrollment.
This rule will require states to submit a report each month from April 2023 to June 2024 of the activities the state has carried out relating to eligibility redeterminations. The CMS will make these reports public. States will be subject to enforcement actions, which include the CMS taking a Federal Medical Assistance Percentage (FMAP) reduction for a quarter, if they fail to meet reporting requirements. The FMAP reduction is determined by the number of percentage points (not to exceed 1 percentage point) equal to the product of 0.25 percentage points and the number of fiscal quarters the state failed to satisfy reporting requirements.
Additionally, the rule authorizes the CMS to take the following enforcement actions if states are not in compliance with reporting or redetermination requirements: (1) states must submit and implement a corrective action plan (CAP) for noncompliance, and (2) if the state fails to submit or implement an approvable CAP, the state must suspend some or all disenrollments from Medicaid for procedural reasons until the state takes appropriate corrective action, impose civil monetary penalties of not more than $100,000 for each day the state is not in compliance, or both.
The polices outlined in the rule are effective as of Dec. 6.