Say Ahhh! readers know that I am a fan of how technology can transform eligibility and significantly improve data collection and reporting. And I’ve been anxiously awaiting signs of progress on the Transformed Medicaid Statistical Information System (T-MSIS) since CMS released an August 2013 letter to State Medicaid Directors indicating that the system was being piloted and that all states were expected to begin to submit monthly data by July 2014. T-MSIS is a critical Medicaid and CHIP data system designed to provide CMS with the information it needs to fulfill its duties in conducting program oversight and to provide other stakeholders with information to evaluate Medicaid and CHIP performance. T-MSIS data include enhanced information about beneficiary eligibility, beneficiary and provider enrollment, service utilization, claims and managed care data, and expenditure data for Medicaid and CHIP.
After scolding CMS about the need for better data for program oversight, GAO issued a priority recommendation on the need for the agency to expedite collection of complete and comparable data. In response, CMS put out new guidance on its plan for expediting T-MSIS implementation and data access.
I last wrote about T-MSIS’ delayed implementation in a blog about the disappointing Medicaid Scorecard, which could be using better indicators if the enhanced data sets that T-MSIS is expected to gather were available. This is important because T-MSIS should be collecting a diverse and abundant amount of information that would allow CMS to report data on a state-level basis using consistent specifications and promoting cross-state comparison in a timely manner. For example, if CMS would enforce timely submission of Medicaid claims/encounter data from all states, T-MSIS could then be used to report the core set quality measures on a consistent and timely basis, thereby reducing administrative burden on states – an often cited goal for this administration.
I appreciate that it’s a heavy lift to launch a big system and to establish interconnectivity to other systems. So rather than fret over the time it’s taken to get to the current status, let’s take stock of where things stand based on this latest guidance.
The good news is that 48 states are submitting monthly information. Two states and one CHIP agency are getting close. But one state – Colorado – is submitting data delayed by more than six months. That suggests a deficiency in the state’s system rather than T-MSIS. The guidance cautions states to consider how any potential system or operational changes could impact the quality, completeness, and/or timeliness of their state’s T-MSIS data submission. Any changes in state vendor contracts should ensure there will not be a degradation in T-MSIS data submissions.
Going forward, CMS has identified 12 top priority areas, which are technical and aimed at ensuring data quality and eliminating duplicate records. CMS will expand this effort to a more comprehensive data quality approach later this year. The agency has set a deadline of six months (February 10, 2019) for states to resolve outstanding data issues. States that are unable to meet this goal will be asked to submit a corrective action plan.
Importantly, the guidance notes that states, Congress, policy researchers, entrepreneurs, and others are eager to access the T-MSIS data. CMS intends to make the T-MSIS data available in a variety of ways, such as analytic files, data marts, routine reports, and an open application program interface. T-MSIS research-ready files should be available in calendar year 2019, although no specific target date was announced. Let’s hope that these timelines for implementation and access to data don’t slip yet again.