BACKGROUND AND JUSTIFICATION STATEMENT
for the
Medicaid Statistical Information System
January 2007 through December 2009
OMB Control No. 0938-0345
Address inquiries regarding this request to:
Denise Franz (410) 786-6117
Finance, Systems and Budget Group
Center for Medicaid and State Operations
9/2006
A. BACKGROUND
The Centers for Medicare and Medicaid Services (CMS) requests the Executive Office of Management and Budget (OMB) clear the Medicaid Statistical Information System (MSIS, IBC Form R-284). This approval would enable States to continue to fulfill their Medicaid data reporting requirements from October 2007 through September 2010.
From 1972 until December 1998, CMS required the annual submission of Medicaid program data in hard-copy format from all States and territories that operate Medicaid programs under Title XIX of the Social Security Act. In 1984 CMS offered States the option to submit enrollment and claims data electronically through MSIS.
Since January 1999, the Balanced Budget Act of 1997 (BBA) has required States to submit their Medicaid data through MSIS. The statutory requirement for a national database provided an impetus for CMS to make a number of significant changes to improve the quality of the data reported starting with fiscal year 1999.
The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) required use of the 2003 MSIS data to develop baseline statistics for the phased-down State contribution process for States to pay back a portion of the prescription drug monies for dually eligible Medicaid/Medicare beneficiaries not expended due to the MMA. No significant changes to MSIS are anticipated for 2006 through 2009.
CURRENT DATA COLLECTION ENVIRONMENT
Medicaid statistical information is reported via the Medicaid Statistical Information System (MSIS). States submit all claims and eligibility data contained in the States' Medicaid Management Information System and ancillary systems. After an automated data edit process and a data quality review performed by CMS contractors, CMS inputs the granular data into a national database. Five data files are submitted each quarter--45 days after the end of the quarter, over 1,000 files into CMS a year.
CURRENT DATA DISSEMINATION ENVIRONMENT
The Medicaid enrollment data for over 50 million individuals and their 2 billion claims each year are submitted by States and input into the national MSIS database. The national State Summary mart allows CMS and partners, through a web based application, to perform data analyses. In addition, CMS produces annual statistical tables for individual State use. Annual national tables are produced and published on the web. A person summary data mart has been developed for CMS use and we are working on clinical marts for drugs, procedures and diagnoses. These marts, although more powerful than the previous marts, will only be available to CMS due to privacy issues. However, CMS will be able to respond to very specific data needs once the clinical marts are complete.
IMPROVEMENTS NEEDED IN MEDICAID STATISTICAL REPORTING
As the Medicaid program has become more complex and Medicaid expenditures consume a greater proportion of State and Federal budgets, improvements in quality, detail, and timeliness of Medicaid statistical reporting have been required. CMS believes that MSIS addresses this issue. The data marts answer actuarial, policy, forecasting, and research needs. In addition the marts respond to issues regarding managed care, welfare reform, the State Child Health Insurance Program (SCHIP), and MMA Dual Eligibles.
QUALITY: The current quality of national Medicaid data is greatly improved. The potential for high quality data has increased with the implementation of a national database. Individual State categorizations and programs complicate the ability for consistent definitions of data. The collection of disaggregated data under MSIS has improved data quality as has additional contractor resources CMS employed, to validate data by reviewing and having States correct detected errors.
DETAIL: The national MSIS database will contain detail (e.g., diagnosis and procedure codes) to allow constructive or predictive analysis of today's Medicaid issues. Analysis of individual eligibility groups (elderly, infants, QMB's, etc.), utilization and payments are simplified with MSIS. MSIS allows for detailed person-level analysis of eligibility and claims information. New MSIS data fields and coding added such as plan identification, improved tracking of adjustments, increased levels of diagnosis and procedure, and more information on eligibility characteristics should facilitate the process.
TIMELINESS: Quarterly reporting of MSIS data 45 days after the end of each quarter allows for early detection of problems and for trending of data for each quarterly time periods. The data quality reviews compare across quarters.
B. JUSTIFICATION
(1) Need/Legal Basis
The Balanced Budget Act of 1997 (Section 4753) mandates that States report their Medicaid data via MSIS. This Act required that all States implement MSIS by January 1, 1999. MSIS (and the preceding HCFA-2082) is used by States and other jurisdictions to report fundamental statistical data on the operation of their Medicaid program. Data provided on eligibles, beneficiaries, payments and services are vital to those studying and assessing Medicaid policies and costs. Medicaid statistical data are routinely requested by Central and Regional Office CMS staffs, Department agencies, the Congress and their research offices, State Medicaid agencies, research organizations, social service interest groups, universities and colleges, and the health care industry. The MMA utilized MSIS data to develop a per capita payment amount for full dual eligible individuals.
PURPOSE FOR THE UPDATE: The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. On January 23, 2004, the Secretary published a Final Rule that adopted the National Provider Identifier (NPI) as this identifier. The implementation date is set for June 2007. The regulation required the NPI, along with the provider taxonomy code, be used for most claims. States that collect these data in their MMIS will submit it to CMS through MSIS. Finally, States have requested we add 2 occurrences for the Internal Control Number (ICN). The ICN is used by States and researchers to track the adjustment of claims and to facilitate review of utilization patterns to identify fraud.
To enable these data to be collected in MSIS, CMS must adjust the size of the claims files. Currently the available filler space on the files will not accommodate this information, and therefore the record length expansion for the CLAIMIP, CLAIMLT, CLAIMOT and CLAIMRX files is necessary. Additional filler space for the existing diagnosis, procedure and service code fields is on the new file formats to allow for the eventual implementation of the ICD-10 codes and other future expansions. The added space, included in these fields at this time, forego another record expansion at some future time and thus avoid more work for States. The NPI implementation is scheduled to take place in June 2007; however for MSIS purposes, this information will be required to be reported beginning FFY 2008. CMS prefers to provide revisions to States at least a year in advance so that State staffs have sufficient lead time to develop, test and implement the changes.
(2) Information Users
The data reported in MSIS are used by Federal, State, and local officials, as well as by private researchers and corporations to monitor past and projected future trends in the Medicaid program. These data provide the only national level information available on enrollees, beneficiaries, and expenditures. They also provide the only national level information available on Medicaid utilization. This information is the basis for analyses and for cost savings estimates for the Department's cost sharing legislative initiatives to Congress.
The data collected by MSIS are also crucial to CMS and HHS actuarial forecasts. The forecasting model used by CMS relies heavily on beneficiary and expenditure data acquired from MSIS.
(3) Information Technology
States’ participation in MSIS by submitting eligibility and claims data is completely electronic.
(4) Duplication of Effort/ Similar Information
There is no duplication of effort or information associated with this request. MSIS provides complete Medicaid program statistics on a national scale and there is no other similar information or report available.
(5) Small Business
Small businesses or other small organizations are not involved and, therefore, will not be affected.
(6) Less Frequent Collection
Medicaid policy makers, which include Congress, HHS, and State governments, rely heavily upon Medicaid statistical data captured by MSIS. The MSIS data provide necessary relevant information essential for effective decision making on the management and future directions of the Medicaid program. The quarterly processing cycles for MSIS are necessary to keep transmission volumes at a reasonable level, and to facilitate timely data quality review and reconciliation. This cycle also improves the availability of data for timely trend analysis.
(7) General Collection Guidelines
This collection effort complies with the guidelines in 5 CFR 1320.6.
(8) Federal Register Notice/Outside Consultations
CMS published a Federal Register notice with a 60-day comment period on October 13, 2006, page 60532.
CMS is constantly in communication with other Federal agencies, health care oriented groups and associations, State Medicaid agencies, independent researchers and others in the health care community. These users and providers of Medicaid statistical data often convey their judgments on the availability of data, frequency of data collection, and other characteristics of the reporting system.
(9) Inducements to Respondents
CMS provides no payments or gifts to States responding to this data collection. The primary benefit of participation is the availability of national data on the Medicaid Program.
(10) Confidentiality
The data collected through MSIS are added to the existing MSIS "System of Records." Provisions of the Privacy Act apply and are strictly enforced. The web-based State Summary Mart does not contain individual identifying information.
(11) Sensitive Questions
This request does not contain information of a sensitive nature. The data reported are data already stored in States' Medicaid Management Information Systems.
(12) Estimate of Burden (Hours and Wages)
The following table shows the detailed summary of the reporting burdens associated with this request. The burden on the States includes the hours associated with producing MSIS tapes for all States.
Estimates of Hourly Burden
MSIS TAPE PRODUCTION
Start up time to implement change: 24 hours per State. No additional effort after the start up.
24 hours x 53 States = 1,272 Hours
Annual burden
53 States Producing MSIS Tapes:
10 hours per response x 4 quarterly responses x 53 States = 2,120 Hours
Average burden – With the one-time start up and the annual burden for 3 years, the average annual burden for the 3 years is 2,544 annually, or 12 hours average per response.
Estimates of Cost Burden
The annual cost for FY 2007 is $101,760 for State staff time.
3,392 hours x $30/hour = $101,760
The annual cost for the burden from FY 2008 – FY 2009 is $63,600 for State staff time.
2,120 hours x $30/hour = $ 63,600
(13) Estimated Annual Operation and Maintenance Costs
There are no annual operating or maintenance costs.
(14) Federal Cost
The annual cost to the Federal Government of collecting the requested data is estimated to be approximately $225,000. These estimates are based upon costs for administrative expenses.
(15) Program/Burden Changes
The slight burden increase is to allow for the startup time to implement the NPI changes. For 2008 and 2009 the annual burden will drop down to 2,120 each year.
(16) Publication and Tabulation Dates
States are required to submit MSIS data on a quarterly basis. These data are edited and compiled. Monthly, quarterly and annual tables are available the end of each fiscal year on the internet and used by a wide variety of federal components, State and local agencies, and private research organizations. A set of 24 annual tables are e-mailed to each State annually. National tables are published on the CMS website. Other major publications utilizing these data include the HCFA Data Compendium and the House Committee on Energy and Commerce "Medicaid Source Book."
(17) Expiration Dates
Display of an expiration date on the MSIS system is impossible. The disclosure statement is printed in the instructions in the State Medicaid Manual.
(18) Exceptions to the Certification Statement
This proposal complies with all conditions included in Certification Statement 19.
C. STATISTICAL METHODS
These information collection requirements do not employ statistical sampling methods.
TERMS OF CLEARANCE
None
| File Type | application/msword |
| Author | HCFA Software Control |
| Last Modified By | CMS |
| File Modified | 2007-02-01 |
| File Created | 2007-02-01 |