The Government Accountability Office has found national Medicaid expenditures in two government databases, the Medicaid Statistical Information System and CMS-64, do not match up for fiscal years 2007 through 2009.
CMS uses two data sets for Medicaid expenditure reporting, and the data have different purposes and limitations. Thus, neither provides a complete picture of Medicaid spending. MSIS provides CMS a summary of expenditures linked to specific beneficiaries on the basis of their medical claims. CMS-64 aggregates states' spending, but this data excludes beneficiary-specific data.
GAO was asked to compare MSIS and CMS-64 data. The agency's report examined the extent to which MSIS and CMS-64 expenditure data differed and, where possible, quantified the differences between the two data sets.
Most expenditures in the MSIS were less than those in CMS-64, according to the GAO report. Forty states reported lower expenditures in MSIS than CMS-64; five states and Washington, D.C., reported higher expenditures; and five states reported equal expenditures.
GAO adjusted MSIS for expenditures that were not attributed to individual beneficiaries, such as prescription drug rebates. These adjustments increased national expenditures in MSIS to 92, 93, and 94 percent of the amounts in CMS-64 in fiscal years 2007 through 2009, respectively. However, the GAO could not account for the remaining differences, partially due to inconsistencies in CMS guidance between the two data sets.
For example, CMS officials explained that expenditures for inpatient services as reported by a state in MSIS and as reported in CMS-64 are not necessarily for the same services.
GAO also found problems with the timeliness of providers' submissions to MSIS. CMS requires states to submit MSIS data within 45 days and CMS-64 data within 30 days of the end of the quarter. However, states' reporting of MSIS data can be up to three years late, whereas CMS-64 data are consistently reported on time.
The GAO concluded that delayed MSIS reporting and inconsistencies between the two data sets limit their usefulness as oversight tools. CMS has recently completed a pilot study aimed in part at improving the timeliness and consistency of both systems, according to the report.
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CMS uses two data sets for Medicaid expenditure reporting, and the data have different purposes and limitations. Thus, neither provides a complete picture of Medicaid spending. MSIS provides CMS a summary of expenditures linked to specific beneficiaries on the basis of their medical claims. CMS-64 aggregates states' spending, but this data excludes beneficiary-specific data.
GAO was asked to compare MSIS and CMS-64 data. The agency's report examined the extent to which MSIS and CMS-64 expenditure data differed and, where possible, quantified the differences between the two data sets.
Most expenditures in the MSIS were less than those in CMS-64, according to the GAO report. Forty states reported lower expenditures in MSIS than CMS-64; five states and Washington, D.C., reported higher expenditures; and five states reported equal expenditures.
GAO adjusted MSIS for expenditures that were not attributed to individual beneficiaries, such as prescription drug rebates. These adjustments increased national expenditures in MSIS to 92, 93, and 94 percent of the amounts in CMS-64 in fiscal years 2007 through 2009, respectively. However, the GAO could not account for the remaining differences, partially due to inconsistencies in CMS guidance between the two data sets.
For example, CMS officials explained that expenditures for inpatient services as reported by a state in MSIS and as reported in CMS-64 are not necessarily for the same services.
GAO also found problems with the timeliness of providers' submissions to MSIS. CMS requires states to submit MSIS data within 45 days and CMS-64 data within 30 days of the end of the quarter. However, states' reporting of MSIS data can be up to three years late, whereas CMS-64 data are consistently reported on time.
The GAO concluded that delayed MSIS reporting and inconsistencies between the two data sets limit their usefulness as oversight tools. CMS has recently completed a pilot study aimed in part at improving the timeliness and consistency of both systems, according to the report.
More Articles on GAO, CMS and Medicaid:
GAO: Providers With $791M in Unpaid Federal Taxes Received $6.6B From Medicaid
GAO: States Want More CMS Guidance for Medicaid Expansion
GAO: Urban, Southern Hospitals Lead in Receiving EHR Payments