In the August 11 Federal Register (75 Fed. Reg. 48816), CMS issued a final rule implementing improvements to the Medicaid Eligibility Quality Control (MEQC) and Payment Error Rate Measurement (PERM) for Medicaid and CHIP.  These measurement reviews are conducted to determine whether the sampled cases meet applicable Medicaid and CHIP fee-for-service, managed care, and eligibility requirements.  The rule implements provisions from the Children’s Health Insurance Program Reauthorization Act of 2009 and makes other operational changes to the programs based on stakeholder feedback. CMS said it received comments from states, advocacy groups, and educational institutions.

About Sam Fish

Sam Fish has over 40 years of legal experience in federal and state human services laws and programs, having joined PCG in 1995 after serving as Chief Counsel, Region I, for the U.S. Department of Health and Human Services for more than 25 years. At PCG, Sam provides legal advice and counsel and has served on many projects that required legal research and interpretation and implementation of many federal and state laws. He has also participated in in-house training in new litigation areas, including Temporary Assistance for Needy Families (TANF), the Balanced Budget Act (BBA), and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). He is available for legal guidance in program areas including school-based billing, third-party liability, Olmstead implementation, and Medicare and Medicaid reimbursement. Currently, he is providing guidance and counsel in the interpretation and implementation of the new health care legislation.

Read More