The Government Accounting Office (GAO) made two recommendations that it believes will expedite the use of state-reported data for oversight of Medicaid.
GAO suggested the CMS improve Transformed Medicaid Statistical Information Systems (T-MSIS) data, including obtaining complete information from all states on unreported T-MSIS data, share information with states on T-MSIS limitations to improve data comparability and implement mechanisms to allow states to collaborate to improve “the completeness, comparability and utility of T-MSIS data.”
The government watchdog also recommended the CMS “articulate a specific plan and associated time frames for using T-MSIS data for oversight.”
GAO conducted the review and provided recommendations after “insufficiencies in state-reported Medicaid data” were found. These issues affect CMS’ ability to oversee Medicaid and led to an estimated $36.7 billion in improper payments in fiscal year 2017.
Though CMS created T-MSIS in 2011 as a way to improve Medicaid data, GAO found problems with the state-reported data despite the CMS working closely with states over the past six years. “It remains unclear when all states will report complete and comparable TMSIS data, and how CMS and states will use them to improve oversight,” according to the report.
The federal government created a data repository and nearly all states submit data that are meant to help “improve oversight and program management,” but there are still “longstanding concerns” with the state data, including issues with “the completeness and comparability of state data."
The organization said the CMS took an important step in implementing T-MSIS, but there's still incomplete data coming from states.
“CMS has taken steps for the initial use of T-MSIS data, but does not have a plan or associated timeframes for using these data for oversight. As a result, important CMS goals for T-MSIS, such as reducing states' reporting burden and enhancing program integrity activities, are not being fully realized,” GAO said.
Despite the issues, GAO said T-MSIS has the potential to improve the CMS’ ability to identify payments and help make sure beneficiaries have access to services.
“By providing more standardized data on various aspects of Medicaid — such as spending or utilization rates — states could be better positioned to compare their programs to other states, thereby improving their ability to identify program inefficiencies or opportunities for improvement. Implementing the T-MSIS initiative has been a significant undertaking,” the government watchdog said.