Federal Oversight of State Medicaid Management Information Systems Could Be Further Improved
HRD-82-99
Published: Jul 30, 1982. Publicly Released: Jul 30, 1982.
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Highlights
GAO reviewed the Medicaid Management Information System (MMIS) to follow up on actions taken by the Department of Health and Human Services (HHS) to implement prior GAO recommendations. On the federal level, MMIS is administered by the Health Care Financing Administration (HCFA).
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | The Secretary, HHS, should direct the Administrator, HCFA, to include in future systems performance review standards and methodology a requirement to measure: (1) operational economy; (2) the states' effectiveness in identifying and correcting program misutilization; (3) contributions of SURS to overall surveillance and utilization review accomplishments; and (4) exception process methodology to better ensure accuracy of SURS data. |
MMIS standards were established to require that group practice physicians be separately identified for SURS profiling and identified through individual provider numbers. HCFA concluded that state cost reporting systems were so varied, it could not make valid comparisons. HHS decided not to implement additional SURS requirements because of the administrative burden placed on the states.
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| Department of Health and Human Services | The Secretary, HHS, should direct the Administrator, HCFA, to clarify instructions to states for reporting Medicaid administrative costs to ensure that costs of personnel who may qualify as skilled professional medical personnel but are engaged in MMIS functions be reported as MMIS operations and costs. |
HCFA has issued Financial Management Review Guides for MMIS and for skilled professional medical personnel. Additionally, HCFA has conducted related followup discussions with appropriate state staff.
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| Department of Health and Human Services | The Secretary, HHS, should direct the Administrator, HCFA, to revise the state Medicaid Manual so that it is consistent with the HHS regulation which requires prior approval or advance notice of ADP equipment and services purchases. |
State Medicaid Manual changes were approved by the Secretary on May 6, 1985, to make them consistent with HHS regulations on ADP prior approval and advance notice.
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Topics
Cost analysisEvaluation criteriaInformation resources managementProgram abusesState-administered programsSystems evaluationSystems managementMedicaidSystems designFederal funding