In a Dec. 6 interim final rule, the Centers for Medicare & Medicaid Services (CMS) implements federal reporting requirements and enforcement authorities related to the end of the Medicaid continuous enrollment requirement in the Social Security Act. These requirements were introduced in the Consolidated Appropriations Act, 2023 (CAA, 2023).
The rule adds reporting requirement regulations discussed in state health official letter #23-002 and FAQ on monetary penalties from June 30. Should states fail to meet these requirements, CMS will provide a notice of noncompliance and states must submit a corrective action plan (CAP). The CAP may include reinstatement of coverage for affected individuals or the suspension of procedural disenrollments.
If a state fails to submit a CAP or CMS disapproves it, CMS can require the state to suspend some or all procedural disenrollments and impose civil monetary penalties of up to $100,000 daily. CMS will consider mitigating circumstances before requiring a CAP, and states can appeal procedural disenrollment suspensions and civil monetary penalties.
CMS will work with states to comply with these reporting requirements and, as long as states put forth a good-faith effort to comply, avoid enforcement. However, CMS does not have the authority to exempt states that fail to meet the CAA, 2023 reporting requirements from the federal medical assistance percentage deduction of 0.25 percentage points for each noncompliant quarter.
This rule is effective Dec 6. Comments were due Feb. 2, 2024.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
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