1. FY 2014 MEDICAID AND CHIP ELIGIBLITY REVIEW PILOT – Round One STATE OF NEVADA Presented by Laura King, Chief, Program Review and Evaluation

2. Evaluate correctness of the MAGI-based Medicaid and CHIP programs. Provide an analysis of the types of errors that were identified. Develop and report on corrective action initiatives.

3.  Nevada was required to review a minimum of 200 MAGI-based Medicaid and CHIP active and negative cases. These cases were sampled from a six month time period, the months of October 2013 through March 2014.  The reviews were to be completed and findings submitted to the Centers for Medicare & Medicaid Services (CMS) no later than June 30, 2014.

4. Resources utilized to complete Pilot QC Staff IT Programming Staff Testing Staff Division of Health Care Financing & Policy EquipmentCMS Staff

5. 156 MAGI- Based reviews were completed. 14 errors were identified. MEDICAID ACTIVE 25MAGI- Based reviews were completed. Zero errors were identified. CHIP ACTIVE 18 Medicaid and 4 CHIP Negative reviews were completed. 2 CHIP Negative errors were identified. NEGATIVES

6. Active Error Trends Active Error Rate was highest in the months of December 2013 and January 2014. The highest active error trends were due to the client not meeting any eligible category and from the Agency failing to properly budget income. Negative Error Trends Negative CHIP Error Rate was highest in January 2014 and February 2014. The CHIP Negative errors cited were cited to the Agency; for failing to requesting unnecessary verifications and for failing to obtain verifications from an electronic source. Agency vs Client The Agency was responsible for 79% of the Medicaid Active Errors, 21% of the errors were attributed to client error. The number of actual errors was much lower than anticipated due to Nevada’s waiver of RD determinations and no terminations due to MAGI- based budgeting during the pilot timeframe.

7. Error is identified, discussed at Round table and Agency is notified in writing of error. Agency accepts error, responds in writing with corrective action taken. Errors cited are discussed at monthly Statewide Process Improvement call, error trends are recorded and published in monthly Agency newsletter. QC schedules a conference with disputing Office, QC reviewer and Program staff. Agency is notified whether Error is rescinded or stands as written. Agency disputes error