Corrective Action Plan Template And Instructions Page 10


Enclosure 3: Instructions for Completing the Payment Error Rate Measurement (PERM)
Medicaid Evaluation of Previous Cycle Corrective Actions Form
The purpose of the evaluation is to determine the effectiveness of the implemented actions using
concrete data. This section documents the outcomes of previously implemented actions in the
prior year’s CAP and any updates to it.
Line-by-Line Instructions: Complete one form for each component of the Medicaid
Line A: Enter the name of the State submitting this report
Enter the Federal fiscal year in which the State is being measured in the PERM
program. This should be the year of the previous corrective action plan.
Line B: Enter the name, telephone number and e-mail address of the State person assigned at
the contact person for the corrective action plan.
Line C: Enter the component for which this corrective action plan reflects (i.e., fee-for- service,
managed care or eligibility).
Line D: Medicaid Narrative instructions - for each component of each program provide a
discussion of the following elements.
For each corrective action listed in the states previous cycle CAP, specify whether the action was
implemented or not implemented.
 For implemented corrective actions:
 Specify when the action was implemented and whether it was implemented in
accordance with the original schedule
 Discuss the status of the corrective action. Specify if the action is complete, in
progress, ongoing, etc. Provide the expected completion date and whether or not
progress is on target
 Evaluate the effectiveness of the corrective action using concrete data. Define the
methods and procedures used for evaluation purposes
 For short term corrective actions be sure to discuss the findings and for long term
corrective actions be sure to provide a status
 For actions not implemented:
 Discuss why the action was not implemented
 Specify whether the action was discontinued, modified, terminated, or replaced with
another corrective action
Include an overall discussion of your state’s ability to meet PERM error rate targets and whether
or not your state was satisfied with the results.


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