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pdfDepartment of Health and Human Services
Centers for Medicare & Medicaid Services
OMB No. 0938-1265
Expires 4/30/2021
Form CMS 64 Summary - Quarterly Medicaid Statement of Expenditures
For the Medical Assistance Program
Summary Sheet
State: Pennsylvania
Quarter Ended: 9/30/2018
Total
Computable
1
Awards Received During The Quarter For The
Quarter Being Reported And Prior Quarters
Awards Received During The Quarter For
Subsequent Quarters
Medicaid
ARRA Federal BIPP Federal
Federal Share Share
Share
Total
Federal Share Computable
Federal Share
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4,658
3,156,231
0
0
2,423
1,641,556
0
0
2,423
1,641,556
0
0
4,925,819
505
0
0
3,668,298
455
0
0
9.C.1. Recoveries: Fraud, Waste and Abuse Efforts
0
0
0
0
0
Recoveries: OIG Compliant False Claims Act
Collections: Other
RAC Collections
PERM Collections
MEQC Collections
Adjustments Decreasing Claims For Prior
10.A. Quarters: Federal Audit
Adjustments Decreasing Claims For Prior
10.B. Quarters: Other
0
0
0
0
(100)
0
0
0
0
(50)
0
0
0
0
0
0
0
0
0
0
0
0
(50)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
3.A.
3.B.
4
5
6
7
8
9.A.
9.B.
Interest: Received On Medicaid Recoveries
Interest: Assessed On Disallowances
Medicare Overpayment Collection Under Sec.
1914 and 42 CFR 447.30
Other
Expenditures In This Quarter
Adjustments Increasing Claims For Prior
Quarters
Other Expenditures
Collections: Third Party Liability
Collections: Probate
9.C.2.
9.D.
9.E.
9.F.
9.G
Form CMS 64 Summary
0
0
0
0
0
0
Report Date: Friday, October 05, 2018 - 12:00 AM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
OMB No. 0938-1265
Expires 4/30/2021
Form CMS 64 Summary - Quarterly Medicaid Statement of Expenditures
For the Medical Assistance Program
Summary Sheet
State: Pennsylvania
Quarter Ended: 9/30/2018
Adjustments Decreasing Claims For Prior
Quarters: Overpayment Adjustments (Attach
10.C. 64.9O)
10.D. Adjustments/Decreasing Prior Qtrs - Perm
10.E. Adjustments/Decreasing Prior Qtrs - RAC
Adjustments/Decreasing Prior Qtrs - Fraud,
10.F. Waste and Abuse Overpayments
Adustments/Decreasing Prior Qtrs - MEQC
10.G. Overpayment Adjustments
Net Expenditures Reported In This Period (Sum
of Items 6, 7 and 8 Less 9 and 10)
11
Form CMS 64 Summary
Total
Computable
Medicaid
ARRA Federal BIPP Federal
Federal Share Share
Share
0
0
0
0
Total
Federal Share Computable
Federal Share
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(100)
(50)
0
0
(50)
0
0
3,160,689
1,643,879
0
0
1,643,879
4,926,324
3,668,753
Report Date: Friday, October 05, 2018 - 12:00 AM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
OMB No. 0938-1265
Expires 4/30/2021
Form CMS 64.9OMEQC - Medicaid Eligibility Quality Control Overpayment Adjustment
State: Pennsylvania
Quarter Ended: 9/30/2018
Total
2015 And
Computable Prior
Overpayments Not Collected Or Adjusted But
Refunded Because Of The Expiration Of The 1
Year Time Limit
1
(100)
0
Decreasing Adjustments To Amounts Previously
Reported On Line 1
2
0
0
Subtotal
3
0
0
Previously Reported Overpayments To
Providers Certified This Quarter As Bankrupt Or
Out Of Business
4
0
0
5
Total Overpayment Adjustments This Quarter
Form CMS 64.9OPerm
(100)
0
2016
2017
Total Federal
2018 Share
0
0
(50)
(50)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(50)
(50)
Report Date: Friday, October 05, 2018 - 12:00 AM
| File Type | application/pdf |
| Author | Christopher Kessler |
| File Modified | 2019-03-12 |
| File Created | 2019-03-12 |