Medicaid Eligibility Sampling Plan Content CMS-317

Medicaid Eligibility Sampling Plan Content
Sampling Plan for: [State]
Fiscal Year: [Year]
Each State operates its MEQC system under a sampling plan approved by the CMS Regional
Office. Before implementation, submit documentation of the proposed plan which describes:
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The population to be sampled;
The list(s) from which the sample is selected;
The sample size;
The sample selection procedure;
The claims collection procedure;
The option to drop or not drop cases selected more than once in the sample period;
The option to use paid claims, billed amounts, and denied claims to offset beneficiary
liability in the eligibility review;
The option to divide multiple service months claim amounts by associated months of
service, or use the date the service was terminated to determine the service month for the
entire claim amount.

CMS implemented MEQC pilots in which States could focus on special studies, targeted
populations, geographic areas or other forms of oversight with CMS approval. States must
submit a sampling plan, or pilot proposal to be approved by CMS before implementing their pilot
program. Minimum set of requirements that must be present in a sampling plan/pilot proposal
are:
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A description of the review;
A description of the sampling unit;
A description of the universe of sampling units, the data source of the universe and the
universe size;
A description of how the sample is selected.