Key Issues > Duplication & Cost Savings > GAO's Action Tracker > Medicaid Personal Care Services (2017-26)
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Health: Medicaid Personal Care Services (2017-26)

The Centers for Medicare & Medicaid Services needs timely, complete, and consistent data on Medicaid personal care services so it can effectively monitor these services, which could lead to tens of millions of dollars in annual savings.

Action:

To improve the collection of complete and consistent personal care services data and better ensure Centers for Medicare & Medicaid Services (CMS) can effectively monitor the services, CMS should establish standard reporting guidance for personal care service claims to ensure that key data reported by states, such as provider identification numbers and the type, quantity, and dates of services, are complete and consistent.

Progress:

In February 2018, CMS distributed guidance to address the challenges states have shown in reporting complete and consistent claims data on Medicaid personal care services, consistent with GAO’s January 2017 recommendation. The guidance clarifies that states are required to include key data elements in each claim for Medicaid personal care services reported through T-MSIS, the agency’s new claims reporting system, including provider identification numbers, dates of service, and quantities of services provided. The guidance also specifies that a national coding system should be used to consistently identify services provided to beneficiaries. By issuing standard reporting guidance, CMS will have better data to oversee Medicaid personal care services.

Implementing Entity:

Centers for Medicare & Medicaid Services

Action:

To improve the collection of complete and consistent personal care services data and better ensure Centers for Medicare & Medicaid Services (CMS) can effectively monitor the services, CMS should better ensure that personal care services data collected from states through CMS-managed data systems for claims and expenditure comply with CMS reporting requirements

Progress:

CMS has taken steps to validate the quality of some personal care service data reported by states through CMS claims data systems, including validation checks of personal care service claims to ensure that key data are not missing or incorrect, but more work is needed to ensure accurate reporting of personal care expenditures, as GAO recommended in January 2017. Specifically, as of November 2018, CMS had not reported that it had addressed inaccurate state reporting of expenditures through CMS’s expenditure reporting system. Complete implementation of the recommended action will better ensure state reporting of claims and expenditures is accurate and will allow CMS to effectively perform key management functions.

Implementing Entity:

Centers for Medicare & Medicaid Services

Action:

To improve the collection of complete and consistent personal care services data and better ensure Centers for Medicare & Medicaid Services (CMS) can effectively monitor the services, CMS should develop plans for analyzing and using personal care services data for program management and oversight.

Progress:

No executive action taken. As of November 2018, CMS had not reported having developed a plan for analyzing and using personal care services data as GAO recommended in January 2017. However, CMS reported that it has taken steps to assess the quality of states’ claims data under the agency’s new claims data system and that it developed monthly data quality metrics to identify quality concerns related to states’ data. CMS also reported that it held a technical evaluation panel in fall 2018 to identify data quality issues, the results of which are being compiled and reviewed. Developing a plan for analyzing and using personal care services data for program management and oversight is an important step CMS needs to take to improve the oversight and management of personal care services.

Implementing Entity:

Centers for Medicare & Medicaid Services