Payment Error Rate Measurement (PERM) 448-01-55-15

(Revised 3/1/12 ML #3304)   

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The Improper Payments Information Act of 2002, enacted on November 26, 2002, requires Federal agencies to review the Medicaid and CHIP programs to estimate the amount of improper payments, to report those estimates to the Congress, and to submit a report on actions the agency is taking to reduce erroneous expenditures. These reviews are conducted to determine whether the sampled cases meet applicable Medicaid and CHIP fee-for-service, managed care, and eligibility requirements. Generally, PERM is conducted in 17 states annually; therefore a single state typically participates in the program once every three years.

 

The state is required to:

 

• Perform active and negative case reviews on statewide random samples of Medicaid and Healthy Steps (ND’s CHIP Program) active cases.

 

• Submit monthly reports to CMS

 

• Calculate error rate measurements and submit to CMS

 

• Assess underlying causes for errors and develop a Corrective Action Plan

 

PERM reviews must be conducted by an agency independent (i.e., such as the Quality Control Unit or an independent contractor) of the State agency responsible for Medicaid and Healthy Steps policies, operations, and program eligibility determinations.