Recovery Audit Contractor Reimbursement Method

In accordance with state law and to clarify methods of reimbursement, the Division of Medicaid and Health Financing (DMHF) will amend Section 4.5 of the Medicaid State Plan concerning the Medicaid Recovery Audit Contractor (RAC) Program.

DMHF will now reimburse recovery audit contractors on a flat-fee basis rather than a contingency basis for the work of identifying overpayments and underpayments in the Medicaid program.

Compared to the most recent three-year weighted average, DMHF does not anticipate any impact to total annual expenditures.

This State Plan Amendment (SPA 16-0027-UT) is pending approval from the Centers for Medicare and Medicaid Services, and if approved, becomes effective 10/01/2016.

A copy of these changes may be obtained from Craig Devashrayee (801-538-6641), or by writing the Technical Writing Unit, Utah Department of Health, P.O. Box 143102, Salt Lake City, UT 84114-3102. Comments are welcome at the same address. Copies are also available at local county health department offices.