OIG: Medicaid data not yet available for system, oversight
A system designed to improve the completeness, accuracy and timeliness of Medicaid data is not yet getting the job done, according to a new audit by the Department of Health and Human Services’ Office of Inspector General.
Data from the Transformed Medicaid Statistical Information System (T-MSIS) was supposed to help ensure the effective administration and oversight of the Medicaid program, including enhancing the ability to identify potential fraud while improving program efficiency.
However, while the Centers for Medicare and Medicaid Services had planned to implement T-MSIS with states on a rolling basis, with the goal 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 problems 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.”
Last 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 identify trends or patterns indicating potential fraud, waste, and abuse in the program—as well as prevent or mitigate the impact of these activities—is significantly diminished.
Although CMS expects that all states will be reporting to T-MSIS by the end of 2017, auditors reveal that only 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 continue to work together to submit data into T-MSIS, they continue to raise concerns about the completeness and reliability of the data,” the report warns. “Specifically, states indicate that they are unable to report data for all the T-MSIS data elements. Additionally, even with a revised data dictionary that provides definitions for each data element, states and CMS report concerns about states’ varying interpretations of data elements. If states do not have uniform interpretations of data elements, the data they submit for these elements will not be consistent across states, making any analysis of national trends or patterns inherently unreliable.”
“Successfully getting all states’ data into T-MSIS requires states and CMS to prioritize T-MSIS implementation,” concludes the report. “Because of CMS’s history of delaying target dates for implementation, OIG is concerned that CMS and states will delay further rather than assign the resources needed to address the outstanding challenges.”
Auditors continue to recommend that CMS establish a deadline for when T-MSIS data will be available for program analysis and other management functions, asserting that “without a fixed deadline, some states and CMS may not make the full implementation of T-MSIS a management priority.”
CMS officials were not 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.
Nonetheless, while progress has been made on the number of states submitting data to T-MSIS, CMS concurred with OIG on the need for reliable data. In its written comments, the agency highlighted its ongoing work to improve data quality.
Specifically, CMS indicated that it has two major goals for T-MSIS data quality: transparency for users, and a continuous, ongoing improvement process with states to strengthen the data quality. To realize these goals, the agency said it is undertaking a variety of actions, including 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 develop an effective working process for improving data quality.
In addition, CMS informed the OIG that it convened a Technical Evaluation Panel to obtain initial feedback on data quality and usability. According to 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.