Medicaid data not still available for system and oversight

A system developed to make better the completeness, precision and timeliness of Medicaid data is not yet getting the job done, in accordance with a new audit by the Department of Health and Human Services’ Office of Inspector General.

Information from the Transformed Medicaid Statistical Information System (T-MSIS) was supposed to assist ensures the effective administration and oversight of the Medicaid data program, involving enhancing the ability to recognize potential fraud while improving program efficiency.

Although, while the CMS (Centers for Medicare and Medicaid Services) had planned to implement T-MSIS with states on a rolling basis, with the aim of having all states submitting data monthly by July 2014, the OIG notes in its report that early implementation challenges have resulted in delays with T-MSIS.

“These delays were caused by technological issues during data testing and by competing priorities for states' IT resources,” according to the OIG’s audit. “As a result, the goal for when T-MSIS will contain data from all state Medicaid programs has been repeatedly postponed.”

Previous year, the federal government and states spent $574 billion on Medicaid, benefitting more than 74 million enrollees. But, without T-MSIS data, the ability to recognize trends or patterns demonstrating potential fraud, waste, and abuse in the program—as well as stop or mitigate the impact of these activities—is primarily diminished.

However, CMS expects that all states will be reporting to T-MSIS by the end of 2017, auditors reveal that just 21 of 53 state programs were submitting data to T-MSIS as of December 2016, and that it is unclear whether an end-of-the-year target date can be met.

“As states and CMS sustain to work together to submit Medicaid data into T-MSIS, they continue to raise concerns about the completeness and reliability of the data,” the report warns. “Particularly, states indicate that they are unable to report Medicaid data for all the T-MSIS data elements. Furthermore, even with a revised data dictionary that gives definitions for each data element, states and CMS report concerns about states’ varying interpretations of data elements. If states don’t have uniform interpretations of data elements, the data they submit for these elements won’t be consistent across states, making any analysis of national trends or patterns inherently unreliable.”

“Successfully getting all states’ data into T-MSIS needs states and CMS to prioritize T-MSIS implementation,” summarizes the report. “Because of CMS’s history of delaying target dates for execution, OIG is concerned that CMS and states will delay further instead to assign the resources required to deal the outstanding challenges.”

Auditors continue to suggest that CMS develop a deadline for when T-MSIS data will be available for program analysis and other management functions, contending that “without a fixed deadline, some states and CMS may not make the full implementation of T-MSIS a management priority.”

CMS officials weren’t immediately available for comment. However, in its written response to the OIG, the agency reported that since December 2016 more states—40 altogether—have successfully started submitting data to T-MSIS.

Nevertheless, while progress has been made on the number of states submitting data to T-MSIS, CMS concurred with OIG on the requirement for reliable data. In its written comments, the agency highlighted its ongoing work to improve data quality.

Specifically, CMS demonstrated that it has 2 major goals for T-MSIS data quality: transparency for users, and a continuous, ongoing improvement process with states to strengthen the Medicaid data quality. To realize these aims, the agency said it is undertaking a variety of actions, involving information for users on data quality, one-on-one technical assistance to states to ensure their data will be usable, as well as a post-production data quality review with a subset of states to establish an effective working process for improving data quality.

Additionally, CMS informed the OIG that it convened a Technical Evaluation Panel to gain initial feedback on data quality and usability. In accordance with the agency, the panel assessed a subset of T-MSIS data to identify anomalies in the data and potential challenges with using the data for analysis. CMS intends to use the panel’s findings to inform efforts to improve the states’ data quality.