OIG Reports on New Medicaid Data System Inadequacies.

Date posted: September 5, 2017

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently reported on deficiencies in the new Medicaid data system. Proper government administration and oversight of the Medicaid program requires complete and accurate data. As such, the Centers for Medicare and Medicaid Services (CMS) developed the new Transformed Medicaid Statistical Information System (T-MSIS) to improve the quality and timeliness of Medicaid data. The OIG noted that historically, incomplete and unreliable Medicaid data has affected program integrity, research, budgeting, and policy. In 2016, the Federal Government and states spent $574 billion on Medicaid, serving more than 74 million enrolled individuals. Given this large expenditure, HHS has designated Medicaid data improvement as a top HHS management challenge.

To conduct the review, the OIG examined the T-MSIS implementation status as of December 2016. The OIG reviewed approved data submission plans from 40 states and interviewed staff from CMS and 16 states about their implementation experiences. The OIG’s report builds upon its 2013 T-MSIS pilot review, and provides an update on T-MSIS implementation efforts.

The OIG reported the following findings:

  1. Early challenges caused delays with T-MSIS implementation;
  2. Technological problems with data testing and competing state resource priorities caused the delays;
  3. CMS has repeatedly postponed the target date for when T-MSIS will contain data from all states;
  4. CMS expects that all states will be reporting to T-MSIS by the end of 2017;
  5. 21 of 53 state programs were submitting data to T-MSIS as of December 2016;
  6. States were unable to report data for all of the T-MSIS data elements;
  7. Varying state interpretations of data elements exist, regardless of revisions to the data dictionary for each data element; and
  8. Without uniform interpretations of data elements, the submitted data will be inconsistent across states, rendering any analysis of national trends or patterns inherently unreliable.

The OIG recommended that CMS:

  1. Prioritize resources towards the T-MSIS data system implementation; and
  2. Establish a deadline for when T-MSIS data will be available for program analysis and other management functions.

The OIG Report is available at: https://oig.hhs.gov/oei/reports/oei-05-15-00050.pdf.

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