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CFR > Title 42 - Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS (parts 430 to 456) > PART 431—STATE ORGANIZATION AND GENERAL ADMINISTRATION > SUBPART Q—Requirements for Estimating Improper Payments in Medicaid and CHIP (§431.950 to §431.1002) > 431.992—Corrective action plan.

CFR

431.992—Corrective action plan.

(a) The State agency must develop a separate corrective action plan for Medicaid and CHIP, which is not required to be approved by CMS, designed to reduce improper payments in each program based on its analysis of the error causes in the FFS, managed care, and eligibility components.
(b) In developing a corrective action plan, the State must take the following actions:
(1) Data analysis. States must conduct data analysis such as reviewing clusters of errors, general error causes, characteristics, and frequency of errors that are associated with improper payments.
(2) Program analysis. States must review the findings of the data analysis to determine the specific programmatic causes to which errors are attributed (for example, provider lack of understanding of the requirement to provide documentation) and to identify root error causes.
(3) Corrective action planning. States must determine the corrective actions to be implemented that address the root error causes.
(4) Implementation and monitoring.
(i) States must develop an implementation schedule for each corrective action initiative and implement those actions in accordance with the schedule.
(ii) The implementation schedule must identify all of the following:
(A) Major tasks.
(B) Key personnel responsible for each activity.
(C) A timeline for each action including target implementation dates, milestones, and monitoring.
(5) Evaluation. States must evaluate the effectiveness of the corrective action by assessing all of the following:
(i) Improvements in operations.
(ii) Efficiencies.
(iii) Number of errors.
(iv) Improper payments.
(c) The State agency must submit to CMS and implement the corrective action plan for the fiscal year it was reviewed no later than 90 calendar days after the date on which the State's Medicaid or CHIP error rates are posted on the CMS contractor's Web site.
(d) The State must submit to CMS a new corrective action plan for each subsequent error rate measurement that contains an update on the status of a previous corrective action plan. Items to address in the new corrective action plan include, but are not limited to the following:
(1) Effectiveness of implemented corrective actions, as assessed using objective data sources.
(2) Discontinued or ineffective actions, actions not implemented, and those actions, if any, that were substituted for such discontinued, ineffective, or abandoned actions.
(3) Findings on short-term corrective actions.
(4) The status of the long-term corrective actions.
[75 FR 48851, Aug. 11, 2010]
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