The Centers for Medicare & Medicaid Services (CMS) launched a new website entitled “State Medicaid RAC’s At-A-Glance.” The website contains a map of the United States, and is designed to track implementation of the Medicaid Recovery Audit Contractor (RAC) program in each state. By hovering the cursor over a state, the website shows you the status of the state plan amendment (SPA), which contains details on how the RAC program would be implemented in that state. It is a necessary prerequisite for implementation of the RAC program. In addition to the status of each state’s SPA, the map indicates the RAC fee structure, which in every case is indicated as “contingency fee.”
States are required to establish a Medicaid RAC Program in accordance with Section 6411 of the Patient Protection and Affordable Care Act (PPACA). The goal of the Medicaid RAC program is to mirror the Medicare RAC program by indentifying and correcting improper payments, whether they be overpayments or underpayments. Under a proposed rule issued by CMS to implement PPACA, states were required to submit their SPAs by December 31, 2010, and fully implement their Medicaid RAC programs by April 1, 2011. But on February 1, 2011, CMS issued a bulletin delaying the original implementation date indefinitely until after CMS issues its final rule later this year.
Providers should take comfort in the delay of the Medicaid RAC program. Although some states may build in some of the protections afforded providers in the Medicare RAC program, there is a need for uniformity across the states, particularly for providers with locations in multiple states. Some of the protections were identified in an excellent letter signed by the American Medical Association and other national and state physician organizations. The letter mentions limitations on the look-back period, record request limits, and oversight of issues to be reviewed as examples of protections afforded to providers in the Medicare RAC program that should be adopted by the Medicaid RAC program.
According to the website, CMS has approved the SPA submitted by six states (Arkansas, Florida, Kansas, Mississippi, South Dakota and Washington), three U.S. territories (America Samoa, Guam and the Northern Mariana Islands) and Puerto Rico. Additionally, all states and U.S. territories have submitted their SPAs except for the District of Columbia, and seven states thus far have requested an exception from some or all of the Medicaid RAC program requirements (Alaska, Kansas, Louisiana, Minnesota, Montana, South Dakota and Wyoming).