CMS Medicaid Program Integrity Toolkit for States

Source: Centers for Medicare & Medicaid Services · Document date: 2021-01-01 · Type: regulation

CMS Program Integrity Toolkit for States, which establishes the 1:10,000 enrollee-to-SIU-investigator ratio as the recommended benchmark for MCO Special Investigation Units. Cited directly in the CMS FY2023 Focused PI Review for Minnesota as the standard against which Minnesota MCO staffing was measured.

Significance: Primary source for the 1:10,000 SIU staffing benchmark. This is a CMS-recommended guideline, not a mandatory regulatory requirement — the benchmark is in the Toolkit, not in 42 CFR 455.

Tags: CMS, SIU, benchmark, toolkit, staffing, MCO