123STA T .4 4 PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9Medica id pl a north e S tate CHIP plan thro ug h reliance ona f inding m ade by an Ex pre s s L ane agency for the duration of the State ’ s election under this para - graph
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‘ ( II ) annually pro v ide the Secretary w ith a statis- tically valid sample (that is approved by Secretary) of the children enrolled in such plans through reliance on such a finding by conducting a full Medicaid eligi- bility review of the children identified for such sample for purposes of determining an eligibility error rate (as described in clause (iv)) with respect to the enroll- ment of such children (and shall not include such chil- dren in any data or samples used for purposes of complying with a Medicaid Eligibility Q uality Control (MEQC) review or a payment error rate measurement (PE R M) re q uirement); ‘‘(III) submit the error rate determined under sub- clause (II) to the Secretary; ‘‘(I V ) if such error rate exceeds 3 percent for either of the first 2 fiscal years in which the State elects to apply this paragraph , demonstrate to the satisfac- tion of the Secretary the specific corrective actions implemented by the State to improve upon such error rate; and ‘‘(V) if such error rate exceeds 3 percent for any fiscal year in which the State elects to apply this paragraph, a reduction in the amount otherwise pay- able to the State under section 190 3(a) for quarters for that fiscal year, equal to the total amount of erro- neous excess payments determined for the fiscal year only with respect to the children included in the sample for the fiscal year that are in excess of a 3 percent error rate with respect to such children . ‘‘(ii) NOPUNIT I VEAC TION B A S E D ONE R ROR RATE. —T he Secretary shall not apply the error rate derived from the sample under clause (i) to the entire population of children enrolled in the State Medicaid plan or the State CHIP plan through reliance on a finding made by an Express Lane agency, or to the population of children enrolled in such plans on the basis of the State’s regular procedures for determining eligibility, or penali z e the State on the basis of such error rate in any manner other than the reduction of payments provided for under clause (i)(V). ‘‘(iii) RU L EO F CONSTRUCTION.—Nothing in this para- graph shall be construed as relieving a State that elects to apply this paragraph from being sub j ect to a penalty under section 1903(u), for payments made under the State Medicaid plan with respect to ineligible individuals and families that are determined to exceed the error rate per- mitted under that section (as determined without regard to the error rate determined under clause (i)(II)). ‘‘(iv) ERROR RATE DEFINED.—In this subparagraph, the term ‘error rate’ means the rate of erroneous excess pay- ments for medical assistance (as defined in section 1903(u)(1)( D )) for the period involved, except that such payments shall be limited to individuals for which eligi- bility determinations are made under this paragraph and Submis si on.Deadl ine. S t atisti c s.
