RD176 - Status of Improper Payment Prevention Pilot – February 1, 2020

Executive Summary:

The Department of Medical Assistance Services (DMAS) has been directed to establish a data analytics pilot to mitigate the risk of improper payments to all Medicaid managed care and fee-for-service providers. The development of this plan is underway, however, progress has been impacted by an amendment approved during the 2019 General Assembly (GA) Session that broadened the scope of work as well as vendor requirements. The GA also created a new requirement in 2019 that technology procurements such as this be subject to extensive review by the Virginia Information Technology Agency (VITA) prior to publishing the Request for Proposal (RFP). The combination of reviews by the Centers for Medicare and Medicaid Services (CMS), Virginia Office of the Attorney General (OAG), and (VITA) has delayed the issuance of the Request for Procurement (RFP) and necessitated adjustments in the proposed project plan.