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More Medicare Data Needed to Integrate Care for Dual Eligibles, State Directors Say

Tuesday, May 15, 2012
State Medicaid directors have urged the Centers for Medicare & Medicaid Services to expand the amount of data it makes available as part of a new initiative allowing states access to Medicare information for so-called dual eligibles, according to a report released May 1 by the National Association of Medicaid Directors (NAMD).

The report, Advancing Medicare and Medicaid Integration: An Update on Improving State Access to Medicare Data, said that the data alignment initiative--started by CMS a year ago--“has made great strides” but still falls short in making Medicare data available in sufficient depth and useful formats.

As a result, the report said, states are unable to make full use of the Medicare information to integrate treatment and cut medical costs for the 9.2 million people eligible for both Medicaid and Medicare.

Dual eligibles, comprising largely the elderly poor with chronic illnesses and the low-income disabled population, account for a disproportionate share of spending in both Medicare and Medicaid.

In an effort to reduce fragmented care delivery--a chief driver of the significant health care costs of dual eligibles--the CMS initiative was designed to allow states greater access to Medicare treatment information (19 HCPR 758, 5/16/11).

CMS Limits Data, Uses.
However, state Medicaid programs cannot take full advantage of the Medicare information because CMS limits its availability and restricts how states can use it, according to the report.
If CMS made available treatment data for Medicare beneficiaries with incomes between 150 percent and 200 percent of the federal poverty level, states could target interventions to this population, preventing or delaying their becoming eligible for Medicaid, the report said.

For example, CMS releases data for only Medicare Parts A, B, and D and prohibits states from using the data for anything other than care coordination between the two programs, the report noted.

The Medicaid directors asked CMS to make available Medicare Part C information covering Medicare Advantage plans, managed care programs offered by private insurers.

With increasing numbers of Medicare enrollees joining Medicare Advantage plans, the NAMD report said, “Part C data would provide information about a beneficiary's history, care management, and service utilization--all essential data elements for state initiatives to integrate care with Medicaid services.”

The Medicaid directors also requested access to “full claims history data” to improve a state's understanding of the utilization patterns of Medicare enrollees.

“This could expand a state's understanding of Medicare pricing information, which in turn impacts the Medicaid delivery system and reimbursement rate structures,” the report said.

Medicare Data Limited to Duals.
The Medicare Part A and Part B data that CMS makes available are limited to dually eligible individuals and leave out “significant information about the Medicare population that is likely to become eligible for Medicaid,” the report noted.

If CMS made available treatment data for Medicare beneficiaries with incomes between 150 percent and 200 percent of the federal poverty level, states could target interventions to this population, preventing or delaying their becoming eligible for Medicaid, according to the report.

Efforts to combat fraud and reduce improper claims from providers also could be improved with additional data, the report suggested. “Without more complete Medicare data, states are challenged in trying to determine if providers listed the correct amounts or in confirming that the claim was for an individual truly enrolled in Medicare,” the NAMD report said.

NAMD also pointed to problems with the formats of the Medicare information made available by CMS. States frequently have to hire outside consultants “to restructure the Medicare data from a text file into the state's preferred format and enter the data into a data warehouse,” the report noted.

To ease states' financial burden and allow easier use of the data, the NAMD report recommended that CMS permit a state to request Medicare data in its preferred format.


The NAMD report is at http://medicaiddirectors.org/node/411.

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