Improving CMS oversight and communication

(a) Improved oversight Section 1903 of the Social Security Act (42 U.S.C. 1396b) is amended by adding at the end the following new subsection: (cc) Improving State payment integrity (1) Definitions In this subsection: (A) Medicaid RAC program The term Medicaid RAC program means a program described in section 1902(a)(42)(B)(i). (B) RAC exception SPA The term RAC exception SPA means a State plan amendment submitted to the Secretary by a State for approval of a full exception from, or an exception to 1 or more of, the requirements described in section 1902(a)(42)(B). (2) Improved oversight of Medicaid RAC program exceptions Not later than 180 days after the date of enactment of this subsection, the Secretary shall establish and implement policies and procedures for the following: (A) Communicate expiration of Medicaid RAC program exception Clearly communicating to a State with an approved RAC exception SPA— (i) the expiration date of the approval; and (ii) a statement that the RAC exception SPA approval expiration date shall not be extended after 2029. (B) Monitoring of RAC exception SPA expirations Monitoring of RAC exception SPA expiration dates and notifying States with respect to any upcoming expiration date. (C) State reports Requiring annual, detailed reporting from a State with an approved RAC exception SPA that includes an overview of the State's Medicaid RAC program, including methodologies and justifications for audit limits or exclusions applied under the program. (3) Improved reporting to Congress on the effectiveness of the Medicaid RAC program (A) In general Not later than December 31, 2027, and annually thereafter, the Secretary, in collaboration with State Medicaid agencies, shall submit to Congress a report describing the effectiveness of the Medicaid RAC program for the most recently ended fiscal year. (B) Contents Each report submitted by the Secretary to Congress under subparagraph (A) shall include the following information with respect to the reporting period: (i) State-specific information For each State: (I) A summary of the State's Medicaid RAC program, including methodologies and justifications for audit limits or exclusions applied under the program, and a description of any approved exceptions. (II) The aggregate amount of Medicaid overpayments recovered and the amount of each overpayment recovered. (III) The aggregate amount of Medicaid underpayments and the amount (actual or estimated) of each underpayment. (IV) If the State that has implemented pre-payment review of Medicaid payments to beneficiaries, the aggregate amount of savings (actual or estimated) attributable to such pre-payment review. (V) The percentage of appeals of demands for overpayment that ended in settlement and, with respect to any such settlement amount, the percentage of such amount in comparison to the original overpayment demanded. (VI) The 5 initiatives most often implemented by the State to reduce overpayments and underpayments. (VII) The number of audit categories— (aa) conducted by a State; or (bb) on hold or denied by a State. (ii) Secretary recommendations Recommendations for expanding or improving the Medicaid RAC program, as the Secretary determines appropriate.. (b) Conforming amendment Section 1902(a)(42)(B)(i) of the Social Security Act (42 U.S.C. 1396a(a)(42)(B)(i)) is amended by inserting (but only through December 31, 2028) after exceptions.