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COMBINED MEDICAID 1507-1 Program Compliance and Quality Control Reviews Supersedes: FMA 1508-2 (01/01/04); MA 1508-1 (02/01/02) Reference: 42 CFR 431.800 through .816; ARM 37.82.101 Overview: Quality Assurance Division (QAD) Program Compliance (PC) staff conduct case reviews based on statistical samples. These reviews provide: 1. a consistent method to measure case determination accuracy; 2. program error rates; and 3. information necessary to create effective corrective action plans. FAILURE/REFUSAL TO COOPERATE: A client who fails or refuses to provide information necessary for PC to complete the review is considered non-compliant. When notified of the non-cooperation, eligibility staff must close the adult client’s Medicaid, providing timely notice of adverse action. Medicaid is only closed when the non- compliance is related to a Medicaid Program Compliance review. The client’s Medicaid cannot be reinstated until they cooperate with the review, regardless of how long it has been since the non- compliance occurred. Effective Date: July 01, 2016