Payment Reduction Related to Certain Erroneous Excess Payments under Medicaid
Section 71106 · Sec. 71106 ·
What this chapter is about
This part tightens how error rates cut federal Medicaid payments. Payments to people not eligible now count as errors. So do payments where eligibility cannot be checked. The change starts with fiscal year 2030.
“by inserting "for audits conducted by the Secretary, or, at the option of the Secretary, audits conducted by the State" after "exceeds 0.03";”
The section inserts into section 1903(u)(1)(A) of the Social Security Act (42 U.S.C. 1396b(u)(1)) words tying the 0.03 error rate to audits by the Secretary or, at the Secretary's option, audits by the State, and adds the words to the extent practicable at the end.
What the document actually says
“by inserting "for audits conducted by the Secretary, or, at the option of the Secretary, audits conducted by the State" after "exceeds 0.03";”
That sentence, in plain words
New words are added after a figure in an older law. They tie it to audits by the Secretary. Audits by the state may count if the Secretary allows.
What this is about
The figure is an allowable error rate of 0.03. Going above it costs the state federal money. The older law is not indexed here.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “may not”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 71106 in the PDF
What the document says
“The amount waived under clause (i) for a fiscal year may not exceed an amount equal to the erroneous excess payments for medical assistance described in subparagraph (D)(i)(II) made for such fiscal year that exceed the allowable error rate of 0.03.”
The section adds a new clause (ii) to section 1903(u)(1)(B) of the Social Security Act capping what the Secretary may waive for a fiscal year at the erroneous excess payments described in subparagraph (D)(i)(II) for that year above the allowable error rate of 0.03.
What the document actually says
“The amount waived under clause (i) for a fiscal year may not exceed an amount equal to the erroneous excess payments for medical assistance described in subparagraph (D)(i)(II) made for such fiscal year that exceed the allowable error rate of 0.03.”
That sentence, in plain words
The Secretary may not waive more than a set sum. That sum is the excess payments above the allowed error rate.
What this is about
Waiving means letting the state off the cut. The cap limits how far that can go. It is worked out year by year.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“payments (other than payments described in subclause (I)) for items and services furnished to an individual who is not eligible for medical assistance under the State plan (or a waiver of such plan) with respect to such items and services, or payments where insufficient information is available to confirm eligibility.”
The section adds a new subclause (III) to section 1903(u)(1)(D)(i) of the Social Security Act bringing within erroneous excess payments those for items and services given to someone not eligible for them, and those where there is not enough information to confirm eligibility. Matching words are added to subclause (II). The changes apply beginning with fiscal year 2030.
What the document actually says
“payments (other than payments described in subclause (I)) for items and services furnished to an individual who is not eligible for medical assistance under the State plan (or a waiver of such plan) with respect to such items and services, or payments where insufficient information is available to confirm eligibility.”
That sentence, in plain words
Some payments now count as errors. One is a payment for care given to someone who does not qualify. Another is one where that cannot be checked.
What this is about
Both add to the state's error figure. A higher figure can cost federal money. The changes start with fiscal year 2030.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
Each distinct thing the section does: tie the error rate to audits by the Secretary or the State, cap the amount that may be waived, widen what counts as an erroneous excess payment, and fix the effective date.
The edit replacing he with the Secretary in subparagraph (C).
The section works by amending section 1903(u)(1) of the Social Security Act, which is not indexed here, so how the error rate reduction works cannot be checked against anything on this site.
