Avoidance of Future Improper Payments Sample Clauses

Avoidance of Future Improper Payments. Agencies: o Source (VA): N/A o Recipient (SPAAs): Total for All State Agencies, Per Year: o Facilitating Agency (HHS/ACF): N/A o DOD/DMDC: N/A o Justice System Agencies: unknown • Public Assistance Clients: improved service delivery to clients, by using computer matching instead of a manual process to determine eligibility; increased resources and less participation stigma for intended program beneficiaries, due to screening out improper beneficiaries • General Public: increased public support for and confidence in the public assistance programs benefitted by the matching program; savings to taxpayers resulting from improved program integrity and efficiency

Avoidance of Future Improper Payments. For advance payments of the Premium Tax Credit, consumers must reconcile the tax credit at the time of tax filing, and so improper payment is mitigated. For state and federal costs associated with Medicaid coverage, the avoidance of future improper payment is not quantified here. However, the use of matching programs mitigates the risk of fraud and abuse by applicants or third parties by requiring that personal information provided on an eligibility application match known data on the individuals. Not applicable, because data from the Marketplace matching programs are not currently used to identify and recover improper payments and debts. Matching Program Structure The Patient Protection and Affordable Care Act, Public Law No. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law No. 111-152 (ACA) requires that each state develop secure electronic interfaces for the exchange of data under a matching program using a single application form for determining eligibility for all state health subsidy programs. CMS has entered into matching agreements with the following federal source agencies: 1) Social Security Administration (SSA), 2) Department of Homeland Security (DHS), 3) Internal Revenue Service (IRS), 4) Veterans Health Administration (VHA), 5) Department of Defense (DoD), 6) Office of Personnel Management (OPM), and 7) the Peace Corps. In addition, CMS has developed a matching program that is executed with every state AE, including state Medicaid and CHIP agencies and State-based Marketplaces. CMS designed the Federal Data Services Hub (Hub) to be a centralized platform for the secure electronic interface that connects all AEs and trusted data sources. Without the Hub, each State AE would be required to enter into a separate arrangement with each federal agency to determine whether applicants for state health subsidy programs are eligible for coverage. If the match operations were conducted through separate arrangements outside of the Hub, the costs to CMS, the source federal agencies, the AEs, and consumers (applicants) would be significantly greater than under the current structure. Background assumptions CMS has made the following assumptions in developing this CBA: For a subset of the TDSs, CMS incurs a cost as the recipient agency. The cost of each data transaction is estimated based on a estimated number of data transactions occurring that year.‌

Avoidance of Future Improper Payments. To Agencies – • Source Agency (OCSE) • Recipient Agency (SSA) The benefits realized from this matching operation include the termination of incorrect monthly benefit payment amounts and the detection and recovery of retroactive overpayments. For FY 2018, the total benefits realized from this matching operation is approximately The systems selected approximately 42,157 CDR cases using quarterly earnings. Of these 42,157 cases, 25,680 cases resulted in termination of monthly benefit payments. The average monthly benefit payment amount was $1,172. The total adjustment in terminated monthly payment amount was $30,096,960. We conservatively predict that without this matching operation these incorrect payments would have continued for 8 months, costing SSA $240,775,680. Therefore, in FY18, we observed a savings of approximately $240,775,680. • Justice Agencies (N/A) To Clients – N/A To the General Public – N/A

Avoidance of Future Improper Payments. To Agencies -

Avoidance of Future Improper Payments. To Agencies – • Source Agency (OCSE) – N/A • Recipient Agency (SSA) – N/A • Justice Agencies – N/A To Clients – N/A To the General Public – N/A

Avoidance of Future Improper Payments. To Agencies • Source Agency: OCSE • Recipient Agency: SSA Between October 2016 and September 2017, SSA Systems reported matching 512,854 NDNH records and sending 380,175 S2, 116,091 S7, and 16,588 U5 alerted cases to the FOs for additional development. The FOs worked 271,957 S2, 81,376 S7, and 12,738 U5 S2 cases. Development of the match alerts resulted in a decrease in the recurring monthly payment in 62 percent of the S2 cases. The average monthly decrease was $415 and the total decrease in monthly payments for all 168,613 cases was $69,974,395. If the match had not occurred, the assumption is that this incorrect payment would have continued for three additional months. Therefore, the estimated savings due to the prevention of erroneous future monthly payments would be about $209,923,185 when projected to the universe of alerts released in FY 2017. Reviewing the S7 alert, retroactive underpayments were found in approximately 4.3 percent of the cases analyzed. The average underpayment per underpaid case is $3,904.48 for the year. Projecting these results to the universe of S7 alerts released in FY 2017, the estimate is that 3,499 cases have retroactive underpayments detected from the match, which total approximately $13,661,776 for FY 2017. Approximately 4.4 percent (3,581) of the S7 cases analyzed had an increase in the monthly payment amount. The average monthly payment adjustment was about $390.45 for a total underpayment of $1,398,201.45. Based on the assumption that this incorrect payment would have continued for three additional months, the estimate of the potential underpayment would be $4,194,604, when projected to the universe of alerts released in FY 2017. While benefit changes due to retroactive underpayments and increases in monthly payment amounts are a benefit to customer service, benefit changes due to retroactive underpayments and monthly payment increases do not present a monetary benefit to the Agency. Therefore, we note these finding totals are notes, but not included in the monetary savings. The FO reduced the recurring monthly payments in 41.6 percent of the U5 cases. The average monthly decrease was $311 and the total decrease in monthly payments for the 5,299 cases was $1,647,989. If the match had not occurred, the assumption is that the incorrect payment would have continued for three additional months. Therefore, the estimated savings due to the prevention of erroneous future monthly payments would be about $4,943,967, when projec...

Avoidance of Future Improper Payments. Quarterly Batch Matching Operation No. of Alerts Completed by FO in FY 2015‌ S2- 13, 568 S7 ­ 3,851‌‌ U5 - 999 Number of Alerts with Change in Monthly Payment Amount 7,870 1,155 1,155 310 Average Change in Monthly Payment Amount $299‌ $647‌ $214‌ $325‌ Total Change in Ongoing Monthly Payment $2,353,130 $747,285 $247,170 $ 100,750 *A change in monthly payment that occurs because of an underpayment is not a monetary benefit to the Social Security Administration. Therefore, the change in monthly payment amount for S7 alerts is not applicable. The benefit change creates an increase in customer service benefit. Quarterly Access to OCSE’s NDNH Online Database SSI‌‌‌ Ticket to Work Number of online queries in FY 2015 6,800,000 788,880 Estimated average program savings per query $58.20 659.28 Savings from not working CDRs $520,092,806 Estimated average title XVI program savings per query $58.20 Total SSI online query program savings $395,760,000 7 The unit cost per CDR was furnished by OPSOS.‌‌‌ 8 Conservative estimate of 40% used to estimate volume based on 2009 percentage of avoided CDR's which was 48.8% (803,914/1,647,364).

Avoidance of Future Improper Payments. Quarterly Batch Matching Operation

Avoidance of Future Improper Payments. Quarterly Batch Matching Operation S2 S7 U5 Alerts Completed by FO in FY 2020 251,366 80,233 11,342 Decreases in Monthly Payment Amount Percent of alerts with Decrease 0.75% 15.25% 0% Projected Alerts with Decrease 1,885 12,236 0 Average Decrease in Monthly Payment Amount $78 $345 0 Total Decrease in Ongoing Monthly Payment $147,030 $4,221,420 0 Projected for 3 months $441,090 $12,664,260 $ 0 Total Benefit -Quarterly Batch $ 13,105,350 S2 S7 U5 Alerts Completed by FO in FY 2020 251,366 80,233 11,342 Increases in Monthly Payment Amount Percent of alerts with Increase 0.75% 15.25% 0% Projected Alerts with Increase 1,885 12,236 0 Average Increase in Monthly Payment Amount $78 $345 0 Total Increase in Ongoing Monthly Payment $147,030 $4,221,420 0 Projected for 3 months $441,090 $12,664,260 $0 Percent of alerts with Underpayment 0% 2.75% 1.75% Number of Alerts with Underpayment 0 2,206 198 Average underpayment amount 0 $2,159 $890 Total underpayment for FY 2020 $0 $4,762,754 $176,220 Estimated Overpayment Recovery Avoidance SSI Query DI Query6 Estimated number of online queries in FY 2020 6,700,000 840,000 Estimated average savings per query $61.227 $952.628 Estimated Savings from Preventing Overpayments and Retroactive Recovery Costs $410,174,000 $800,200,800