Since 1978, the Medicaid Eligibility Quality Control (MEQC) program has gone through several iterations. On July 5, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final regulation entitled Changes to the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) Programs (CMS-6068-F). This regulation restructured the MEQC program into an ongoing series of pilots that are closely coordinated with CMS’s Payment Error Rate Measurement (PERM) program.
Under the MEQC program, states design and conduct projects, known as pilots, to evaluate the processes that determine an individual’s eligibility for Medicaid and Children’s Health Insurance Program (CHIP) benefits. States have great flexibility in designing pilots to identify vulnerable or error-prone areas. In addition, states conduct MEQC pilots during the two-year intervals (“off-years”) that occur between their triennial PERM review years. The MEQC program does not generate an error rate.
When an MEQC pilot concludes, the state must submit to CMS both a case-level report on the results of their pilots and payment reviews, as well as a corrective action plan (CAP) to address the errors and deficiencies identified through the pilot work.
MEQC program guidance documents are included in the section below. This guidance provides states with information about the general requirements in the regulation and detailed specifications regarding the MEQC pilot planning documents that each state is required to submit on November 1 of the year in which their PERM review is completed. Additional guidance regarding details about case-level reports, payment reviews, and CAPs will be released in the future.
MEQC Guidance
- MEQC Phase 1 Sub-Regulatory Guidance Effective May 13, 2021
- MEQC Supplemental Guidance May 13, 2021
- Attachment A: Summary MEQC Template May 13, 2021
- Attachment B: MEQC Case Level Reporting Template May 13, 2021
- MEQC COVID-19 Supplementary Guidance August 17, 2020
- MEQC Phase 1 Sub-Regulatory Guidance Effective August 17, 2020
- MEQC Sub Regulatory Guidance Effective October 22, 2018
- MEQC Guidance Cover Letter August 29, 2018
- MEQC Sub Regulatory Guidance Effective August 29, 2018