Best Practices for SMAs

Best Practices for State Medicaid Agencies

CMS’ Medicaid Integrity Program collects and analyzes information about state program integrity efforts and creates guidance and best practices to help states. The resources below cover important topics such as provider enrollment, interactions with Medicaid Fraud Control Units, data analytics, and more.

• Best Practices for Medicaid Program Integrity Units' Collection of Disclosures in Provider Enrollment (PDF)
  Best practices to improve provider enrollment policies, collection of provider disclosures, and conducting exclusion searches. Also covers how to report adverse provider actions. (10 pages)
• Best Practices for Medicaid Program Integrity Units' Interactions with Medicaid Fraud Control Units (PDF)
  Guidance and best practices for interactions between State Program Integrity Units (PIUs) and their Medicaid Fraud Control Units (MFCUs). (9 pages)
• Data Analytic Capabilities Assessment for Medicaid Program Integrity (PDF)
  Introduces states to data analytics and predictive modeling products. Helps states assess their readiness to introduce predictive modeling into their program integrity environments. (21 pages)
• Performance Standard for Referrals of Suspected Fraud from a Single State Agency to a Medicaid Fraud Control Unit (PDF)
  Guidance on how to calculate the percentage of acceptable referrals provided by a State Medicaid agency to its MFCU. (2 pages)
• Vulnerabilities and Mitigation Strategies in Medicaid Personal Care Services (PCS) (PDF) Best practices to help states more effectively ensure beneficiary safety and prevent improper Medicaid payments in Medicaid Personal Care Services (PCS). (35 pages)

Related Links

• Provider Requirements
• Infographics
• State Program Integrity Reviews