Resources for SMAs

Resources for State Medicaid Agencies

We have created the resources below to help you successfully manage your state’s Medicaid program integrity activities, train your staff, and educate providers. These resources include best practices on a variety of topics, informative resources about provider requirements, and frequent findings from state program integrity reports. We have also created one-page infographics on relevant topics that are especially useful for training and education.

Infographics

The one-page infographics below provide quick overviews of commonly challenging topics in Medicaid. These infographics can be posted in offices or waiting areas and can be used as part of training and education programs for state staff, providers, or beneficiaries.

Best Practices for State Medicaid Agencies

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 of 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 (PDF)
Best practices to help states more effectively ensure beneficiary safety and prevent improper Medicaid payments in Medicaid Personal Care Services (PCS). (35 pages)

Provider Requirements

We have created the resources below to help states with a range of topics in provider management including enrollment, ownership and control, payments, and more. States can also use these resources to educate providers and improve compliance. Most of the resources are short fact sheets that provide high-level information on topics. We also provide frequent findings from State Program Integrity Reviews on select topics in provider management.