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) > 431.988—Eligibility case review completion deadlines and submittal of reports.

431.988—Eligibility case review completion deadlines and submittal of reports.

(a) (1) States must complete and report to CMS the findings, including total number of cases in the eligibility universe, the error causes for all case reviews listed on the monthly sample selection lists, including cases dropped from review due to active fraud investigations, and cases for which eligibility could not be determined.
(2) States must submit a summary report of the active case eligibility and payment review findings to CMS by July 1 following the review year.
(b) The agency must report by July 1 following the review year, information as follows:
(1) Case and payment error data for active cases.
(2) Case error data for negative cases.
(3) Identify the last action on a case, either application or redetermination for States that do not stratify the eligibility sample in accordance with § 431.978(d)(3)(i) of this subpart.
(4) The number and amounts of undetermined cases in the sample and the total amount of payments from all undetermined cases.
(5) The number of cases dropped from review due to active fraud investigations.
[71 FR 51081, Aug. 28, 2006, as amended at 75 FR 48851, Aug. 11, 2010]