T-MSIS Data Not Yet Available for Overseeing Medicaid

WHY OIG DID THIS REVIEW

In 2016, the Federal Government and States spent $574 billion on Medicaid, serving more than 74 million enrolled individuals. Complete, accurate, and timely Medicaid data are vital for the effective administration and oversight of the Medicaid program by States and the Federal Government. Historically, problems with Medicaid data have hindered program integrity, research, budgeting, and policy. Consequently, OIG has designated the improvement of Medicaid data as a top management challenge facing the Department of Health and Human Services. The Transformed Medicaid Statistical Information System (T-MSIS) is a new data system intended to improve the completeness, accuracy, and timeliness of Medicaid data.

This review provides a status update on the implementation of T-MSIS, building on OIG's 2013 review of the T-MSIS pilot.

HOW OIG DID THIS REVIEW

We analyzed the implementation status of T-MSIS as of December 2016 using 40 States' approved plans for data submission. In addition, we interviewed staff from CMS and 16 States about their experiences implementing T-MSIS.

WHAT OIG FOUND

States and CMS 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. As a result, the goal for when T-MSIS will contain data from all State Medicaid programs has been repeatedly postponed. Most recently, CMS indicated that it expects that all States will be reporting to T-MSIS by the end of 2017. As of December 2016, 21 of 53 State programs were submitting data to T-MSIS. 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; OIG raised these same concerns in our 2013 review of the T-MSIS pilot. 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.

CONCLUSION

Successfully getting all States' data into T-MSIS requires States and CMS to prioritize T-MSIS implementation. 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. Thus, OIG continues to support our 2013 recommendation that CMS establish a deadline for when T-MSIS data will be available for program analysis and other management functions. Without a fixed deadline, some States and CMS may not make the full implementation of T-MSIS a management priority.