CMS’ Personal Care Oversight Hurt by Poor Data
February 16, 2017 07:36 AM
The Medicaid program lacks the data to properly prevent fraud and abuse and the Centers for Medicare and Medicaid Services (CMS) should provide guidance to remedy the situation, according to a new report from the nonpartisan Government Accountability Office (GAO).
The GAO recommended that CMS improve personal care services data by:
establishing standard reporting guidance for key data;
ensuring linkage between data on services provided and expenditures reported;
ensuring state compliance with reporting requirements;
developing plans to use data for oversight.
The Medicaid Statistical Information System (MSIS) and the Medicaid Budget and Expenditure System (MBES) collect data for the CMS that can be used to broadly describe the spending on and provision of Medicaid personal care services. However, the utility of the data is severely limited because of errors and gaps in the information, the GAO found. CMS must have timely and reliable data on personal care services provided and the amounts paid for it, but the GAO found the information collected by the MSIS and MBES did not always meet those standards.
For example, 15% of MSIS claims lacked provider identification numbers, and there were more than 400 different procedure codes used to identify services provided, during the time of the GAO investigation. For the MBES, about 17 percent of expenditure lines were reported incorrectly.
Medicaid spent about $80 billion to provide assistance with activities of daily living in home-and-community-based settings in 2014 – more than institutional long-term care, according to the GAO. That figure is expected to rise with a corresponding increase in demand for home-and-community-based health care.
The report found almost $5 billion worth of claims in 2012 did not identify the provider of the service, according to the GAO.
The Department of Health and Human Services, which includes CMS, agreed that the CMS should ensure that states comply with reporting requirements and develop plans to use data to oversee the provision for and spending on personal care services. However, the HHS did not agree or disagree that CMS should develop stnadardized guidance for reporting of key data by states and ensure that data on services provided link with reported expenditures.