The State of Data Quality for Medicaid & Future Roadmap for Success

Elkridge, MD, July 19, 2021 – In a series of recent letters to State Health Officials, the Centers for Medicare & Medicaid Services (CMS) has shown a growing desire to improve Medicaid and Children’s Health Insurance Program (CHIP) data and analytics through the Transformed Medicaid Statistical Information System (T-MSIS) dataset, a modernized version of the previous Medicaid Statistical Information System (MSIS) file format for Medicaid and CHIP data.

In a 2013 letter to State Health Officials, CMS announced T-MSIS would be implemented with states on a rolling basis, with the ultimate goal of requesting states to submit monthly data by July 1, 2014. In this letter, CMS communicated the benefits of having an enhanced dataset available for states, one that would offer states and CMS the ability to observe trends on a greater scale, analyze expenditures, and create enhanced anti-fraud, waste, and abuse capabilities.

In a follow-up 2018 State Health Official (SHO) letter, CMS addressed concerns about a lack of access to high quality, timely, Medicaid and CHIP data from states.

In response to the growing concern about T-MSIS data quality, CMS introduced Data Quality Priorities for post-production data quality; areas that all states should address as a part of their T-MSIS data reporting for improvement. CMS also challenged states to regularly review and assess their datasets by submitting T-MSIS data reports to CMS, a new requirement as a permanent and ongoing process of state operations (SHO-2018).

As noted in the 2018 letter, if states are not able to maintain T-MSIS compliance, CMS may reduce the enhanced Federal Financial Participation (FFP) operational costs of systems that are unable to produce accurate and complete T-MSIS reporting.

In the latest CMCS Informational Bulletin in 2019, CMS outlined new requirements for states to maintain monthly production submissions of T-MSIS files and encouraged states to identify areas that need improvement while continuing to refine the key TPIs as identified in the T-MSIS operations dashboard.

Where does this leave us today?

As the healthcare landscape continues to evolve towards data-driven analytics and advanced reporting, CMS has illustrated through its State Health Official letters an intent to require sophisticated, timely, accurate T-MSIS data. The letters also indicate a strong desire for states to leverage innovative systems to review and improve their T-MSIS data quality. By placing an increasing priority on improving data quality through T-MSIS, CMS will be able to strengthen its Medicaid and Children’s Health Insurance Programming and therefore provide better care to the 73 million Americans the Medicaid and CHIP programs currently support.

To ensure states prioritize taking steps towards improving their data quality, CMS outlines clear guidelines for states to resolve areas which need improvement immediately and no later than six months after receipt of the initial notice in the 2018 State Health Official letter.

To help address the financial implications of leveraging new technology to make T-MSIS improvements, CMS provides an option for states to request 90/10 enhanced system funding through the Advanced Planning Document process to assist in supporting the necessary system enhancements required to comply with CMS T-MSIS data quality requirements.

What should states be looking for in a T-MSIS solution?

State health officials can overcome challenges with T-MSIS data reporting by implementing Imersis, a cloud-based Medicaid data quality solution developed in partnership by NewWave and Mathematica.

Imersis enables state Medicaid agencies to leverage powerful data analytics to review, refine, and improve T-MSIS data scores before data is submitted to CMS. Built to leverage the Google cloud, Imersis scores data files the same way as CMS does, providing TPI scores in days, instead of weeks. This extra time allows states to make key TPI improvements before final data is submitted to CMS.

Drawing from decades of experience working with CMS and Medicaid data, NewWave brings 15+ years of experience working with CMS data and maintaining the CMS Chronic Conditions Warehouse (CCW). Mathematica brings 25+ years of experience with MSIS and T-MSIS data, a rich understanding of CMS data quality assessment methods (DQ Atlas) and subject matter expertise in Medicaid programs, state data, and federal T-MSIS file format.

It’s clear the healthcare landscape is changing. Imersis puts the power back in the hands of states to take control of their data to make improvements, creating a path forward for states to leverage deep analytics and advanced data visualization as a key part of their Medicaid programs.

Learn more about Imersis at the 2021 Medicaid Enterprise Systems Conference (MESC) where you can connect with NewWave and Mathematica experts at booth 213.

Also, in the weeks ahead, follow us on Twitter where Mathematica and NewWave experts will share their insight and thoughts on attending this year’s MESC.

If you would like to get in touch with the Imersis experts and schedule a demo, please email us at [email protected] directly.