The Centers for Medicare and Medicaid Services does not have sufficient data to consistently inform its oversight of Medicaid payments, according to a recent Government Accountability Office report.
Examining the state-provided Medicaid expenditure and service utilization information available to CMS, the agency within the Department of Health and Human Services that administers the Medicaid program, GAO determined the data saddled program management with limitations due to issues with completeness, accuracy and timeliness.
CMS data comes from two key sources: the CMS-64, which serves as the basis for calculating the amount of federal matching funds for states, and the Medicaid Statistical Information System, which is designed to report individual beneficiary claims data.
GAO’s review of agency guidance, laws, regulations, internal controls and reports from March 2010 through September 2016 revealed that data provided an incomplete picture of how states finance their portion of program costs and delayed utilization reports hampered CMS’ ability to identify inappropriate provider behavior or ensure beneficiaries can access services.
GAO’s recommendations to HHS include having CMS expedite its efforts to improve Medicaid data through the Transformed Medicaid Statistical Information System initiative (estimated to cover 70 percent of the Medicaid population by the end of 2016). The push for states to implement new Medicaid information technology systems alongside CMS’ evolving plans for applying the data is intended to improve deficiencies.
The entire report can be found on GAO’s website.
Medicaid program needs better data for better oversight, says GAO
