Tech hurdles delaying flow of Medicaid data, impatient OIG says
A new Office of Inspector General report shows the Centers for Medicare and Medicaid Services, along with many state Medicaid agencies, reporting big challenges in submitting data to the Transformed Medicaid Statistical Information System, which was supposed to be fully operational by now.
Technology hurdles, limited resources and data governance challenges are all contributing to the long-delayed deployment.
The T-MSIS database is meant to keep tabs on crucial cost and quality data, from across more than 50 state Medicaid programs.
"Historically, problems with Medicaid data have hindered program integrity, research, budgeting and policy," according to OIG, which has cited improving Medicaid data as a "top management challenge" for HHS.
So CMS and the state Medicaid agencies collaborated on the T-MSIS project, a $100 million IT system meant to upgrade information sharing to help assess the data for completeness, accuracy and timeliness.
T-MSIS was first piloted with a dozen states in 2011. A separate OIG review soon found some challenges with their use of the technology a raised questions about whether T-MSIS data would be complete and accurate upon a nationwide rollout.
It also took issue with the fact that CMS had not established a deadline for when national T-MSIS data would be available.
In summer 2013, CMS told state Medicare directors that it would implement T-MSIS nationwide on a rolling basis, with the goal for all states to be submitting monthly data by July 2014.
Since then, the date upon which all states would be reporting data "has been repeatedly postponed," according to the follow-up OIG report issued this month.
A combination of technological problems during data testing and competing priorities for states' limited IT resources has continued to cause delays. CMS most recently said that it expects that all states will be reporting to T-MSIS by the end of 2017.
Even if that happens – and it might be a challenge, given that as of six months ago just 21 of 53 state programs were submitting to the system – another big problem is that states and CMS have also reported concerns related to the completeness and reliability of the data, according to OIG.
Data governance is a central challenge to the T-MSIS project, according to the report, which points out that "to improve Medicaid program oversight CMS requires states to submit new files and data elements for T-MSIS."
CMS established more than 1,000 data elements for T-MSIS – more than double the 400 collected in the original MSIS system. T-MSIS also expands on the original five MSIS file types – eligibility and four types of claims: inpatient, long-term care, pharmacy, and other – by adding files for third-party liability, information from managed care plans and providers, OIG said.
"States indicate that they are unable to report data for all the T-MSIS data elements," according to the report. "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." Without uniform interpretations of the data, clearly, "any analysis of national trends or patterns (is) inherently unreliable."
Bottom line: OIG’s patience is wearing thin.
"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," officials said. "Without a fixed deadline, some states and CMS may not make the full implementation of T-MSIS a management priority."