CMS needs better data to monitor personal care services in Medicaid, GAO says

Medicaid on paper and a stethoscope
Medicaid spending on personal care services now exceeds spending on institutional long-term care. (Getty/designer491)

In order to provide more effective oversight of personal care services in the Medicaid program, the federal government needs better data, according to a new report.

The report, from the Government Accountability Office, notes that personal care services—those provided in home or community settings—account for a growing share of long-term care spending under Medicaid, with spending on such services reaching $80 billion in 2014.

Two data systems managed by the Centers for Medicare & Medicaid Services collect information from states about personal care services: the Medicaid Statistical Information System (MSIS) and the Medicaid Budget and Expenditure System (MBES). But gaps and errors in the data these systems collect limit their usefulness, the report says.

In the MBES system, for example, the GAO found that 17% of expenditure lines were not reported correctly from 2012 to 2015, and nearly two-thirds of these errors were due to states not separately identifying personal care services expenditures, as required by CMS.

The most recent data available in the MSIS system, meanwhile, were from 2012 and only included 35 states at the time of the GAO’s audit. In addition, 15% of claims lacked provider identification numbers, more 400 different procedure codes were used to identify the services, “and the quantity and time periods varied widely,” the report says.

While CMS plans to replace the MSIS system and has created a new office to help the agency use data to manage and monitor its programs, it has not yet issued guidance that addresses the reporting gaps GAO identified in personal care services, nor developed plans to use the data for oversight purposes, according to the GAO.

Thus, the GAO recommends CMS do the following:

  • Establish standard reporting guidance for key personal care services data
  • Ensure linkage between data on the provision of services and reported expenditures
  • Ensure state compliance with reporting requirements
  • Develop plans to use data for oversight

“Without improved data and plans for how it can be used for oversight, CMS could continue to lack critical information on personal care service expenditures,” the report concludes.

Similarly, a previous report from the Department of Health and Human Services Office of Inspector General highlighted “significant and persistent compliance, payment and fraud vulnerabilities” in Medicaid personal care services, recommending that CMS step up its oversight.