Payment Error Rate Measurement (PERM)
In response to the Improper Payments Information Act of 2002, the federal Office of Management and Budget identified Medicaid and the Children's Health Insurance Program as programs at risk for significant improper payments. As a result, the Centers for Medicare and Medicaid Services (CMS) developed the Payment Error Rate Measurement (PERM) program.
The PERM program measures improper payments in Medicaid and CHIP and produces error rates for each program. The error rates are based on reviews of the fee-for-service, managed care, and eligibility components of Medicaid and CHIP in the Federal Review Year under review. It is important to note that the PERM improper payment rate is not a "fraud rate," but simply a measurement of payments made that did not meet statutory, regulatory, or administrative requirements.
The PERM program uses a three-year rotation to produce and report national Medicaid and CHIP improper payment rates. This information is shared with Congress. There are three cycles, each containing 17 states (50 states and the District of Columbia). Pennsylvania is part of Cycle 1. The PERM Audit takes approximately 2.5 years to complete.
The Department of Human Services' PERM team consists of representatives from the Office of Medical Assistance Programs, Office of Income Maintenance, Office of the Budget, Office of Long Term Living, Office of Developmental Programs, Office of CHIP, and Office of Administration (OA). The Bureau of Program Integrity, under the Office of Administration, manages the PERM process for Pennsylvania and serves as the liaison between DHS and the CMS and the federal contractors.
The Review Year 2019 PERM audit was Pennsylvania's last completed PERM cycle. The Commonwealth audit outcomes, are listed below, along with the National Rolling Error Rates and the Cycle 1 Error Rates. The commonwealth performed better than many other Cycle 1 states and also on the National level. It is also important to note, this was the first PERM cycle where eligibility was included in the PERM audit.
| ||Overall %||FFS %||MC %||Eligibility %|
|RY19 PA Medicaid Rates||14.24%||8.74%||0.00%||11.36%|
|2020 National Rolling Medicaid Rates ||21.36%||16.84%||.06%||14.94%|
|RY19 Cycle 1 Medicaid Rates ||26.18%||15.12%||0.00%||20.60%|
|RY19 PA CHIP Rates||20.67%||0.00%||11.31%||10.55%|
|2020 National Rolling CHIP Rates||27.00%||14.14%||0.49%||23.53%|
|RY19 Cycle 1 CHIP Rates||37.75%||15.29%||2.91%||32.97%|
Listed below are the final reports received from CMS for the Review Year 2019 PERM Audit for PA:
Provider Quick Tips related to PERM
Medical Records Request
Providers can expect Medical Record Request Letters from Chickasaw Nation Industries (CNI) to begin in September 2018. Below are examples of correspondence you may receive from CNI.
Federal Contractors Conducting the PERM Audit
The Statistical Contractor (SC):
The Lewin Group
3160 Fairview Park Drive, Suite 600
Falls Church, VA 22042
Central PERM Mailbox: PERMSC.firstname.lastname@example.org
The Review Contractor (RC):
1530 E. Parham Road
Henrico, VA 23228
General Mailbox: email@example.com
The Eligibility Review Contractor (ERC):
Booz Allen Hamilton
20 M Street SE
Washington, DC 20003
Central PERM Mailbox: PERM_ERC_RY2022@bah.com
STATE PERM LEADS FOR DHS:
Christine Kline (PERM Coordinator and Medicaid-Claims Primary)
Phone: 717-705-6851 | Email: firstname.lastname@example.org
Patricia Weik (Medicaid- Eligibility)
Phone: 717-787-5499 | Email: email@example.com
Virginia Perry (CHIP)
Phone: 717-772-1110 | firstname.lastname@example.org
Link to Additional Provider Information
The "providers" page helps to better understand the PERM process and what
you may be required to do during a review.