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Can a state make a qualified hospital liable when a PE determination results in a denial of Medicaid eligibility?

There is no recoupment for Medicaid services provided during a PE period resulting from erroneous determinations made by qualified entities. Payment for services covered under the state plan (as well as federal financial participation) is guaranteed during a PE period; without such a guarantee, providers could not rely on the PE determination. As noted, states have various ways to ensure that hospitals are making appropriate PE determinations and must fulfill their oversight responsibilities.

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Date
FAQ ID
91711
FAQ Question
Can a state make a qualified hospital liable when a PE determination results in a denial of Medicaid eligibility?