FY 2014 MEDICAID AND CHIP ELIGIBLITY REVIEW PILOT – Round One
STATE OF NEVADA
Presented by Laura King, Chief, Program Review and Evaluation
PILOT FINDINGS
PILOT GOALS
Develop and report
on corrective action
initiatives.
Evaluate
correctness of the
MAGI-based
Medicaid and CHIP
programs.
Provide an analysis
of the types of
errors that were
identified.
SAMPLE SIZE
Nevada was required to review a minimum of 200
MAGI-based Medicaid and CHIP active and
negative cases. These cases were sampled from a
six month time period, the months of October
2013 through March 2014.
´ The reviews were to be completed and findings
submitted to the Centers for Medicare & Medicaid
Services (CMS) no later than June 30, 2014.
´
TEAM RESOURCES
QC Staff
IT
Programming
Staff
CMS Staff
Resources
utilized to
complete
Pilot
Equipment
Testing Staff
Division of
Health Care
Financing &
Policy
PILOT ERROR ANALYSIS
MEDICAID
ACTIVE
CHIP
ACTIVE
•156 MAGIBased reviews
were
completed.
14 errors
were
identified.
•25MAGIBased reviews
were
completed.
Zero errors
were
identified.
NEGATIVES
•18 Medicaid
and 4 CHIP
Negative
reviews were
completed. 2
CHIP Negative
errors were
identified.
PILOT ANALYSIS, CONT.
Active Error Trends
•Active Error Rate was highest in the months of December 2013 and
January 2014.
•The highest active error trends were due to the client not meeting any
eligible category and from the Agency failing to properly budget income.
Negative Error Trends
•Negative CHIP Error Rate was highest in January 2014 and February
2014.
•The CHIP Negative errors cited were cited to the Agency; for failing to
requesting unnecessary verifications and for failing to obtain verifications
from an electronic source.
Agency vs Client
•The Agency was responsible for 79% of the Medicaid Active Errors, 21%
of the errors were attributed to client error.
•The number of actual errors was much lower than anticipated due to
Nevada’s waiver of RD determinations and no terminations due to MAGIbased budgeting during the pilot timeframe.
CORRECTIVE ACTION
Error is identified,
discussed at Round
table and Agency is
notified in writing of
error.
Agency disputes error
Agency accepts error,
responds in writing
with corrective action
taken.
QC schedules a conference
with disputing Office, QC
reviewer and Program staff .
Agency is notified whether
Error is rescinded or stands
as written.
Errors cited are
discussed at monthly
Statewide Process
Improvement call,
error trends are
recorded and
published in monthly
Agency newsletter.
FINAL THOUGHTS