Brochure. ACA Compliance. What is being mandated for T-MSIS and State Medicaid agencies and how can you achieve compliance?

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1 Brochure What is being mandated for T-MSIS and State Medicaid agencies and how can you achieve compliance?

2 Truven Health Analytics was acquired by IBM in 2016 to help form a new business, Watson Health. Watson Health aspires to improve lives and give hope by delivering innovation to address the world s most pressing health challenges through data and cognitive insights. T-MSIS and State Medicaid agencies The mandate T-MSIS, which stands for Transformed Medicaid Statistical Information System, is an expansion of the existing Centers for Medicare & Medicaid (CMS) MSIS extract process. T-MSIS is mandated by CMS and the Affordable Care Act (ACA), and is a natural extension of current Decision Support Systems (DSS) and data warehouse solutions in state agencies today. As part of the CMS plan to improve and expand upon its Medicaid data repository, states are required to augment the current MSIS data extracts. Currently, each state submits five MSIS extracts to CMS on a quarterly basis. These data are used by CMS to assist in federal reporting for the Medicaid and Children s Health Insurance Program (CHIP). Several reasons culminated in the CMS mission to improve the repository, including incomplete data, questionable results, multiple data collections from states, multiple federal data platforms and analytic difficulties in interpreting and presenting the results. In addition, timeliness issues have prompted CMS to re-evaluate its processes and move toward a streamlined delivery, along with an enhanced data repository. The new T-MSIS extract format and frequency are expected to further CMS goals for improved timeliness, reliability and robustness through monthly updates and an increase in the amount of data requested. Fortunately, Truven Health Analytics, part of the IBM Watson Health business, has extensive experience in this area and can support states in achieving compliance with new federal requirements. Achieving compliance The Truven Health experience and expertise can help states meet the T-MSIS federal requirements efficiently and allow for ad-hoc modifications as needed. We have other state experience with the existing MSIS quarterly submission process, including verifying error tolerances and distributions of valid values. Additionally, our experience with MSIS expands beyond the individual state level; we have completed a number of MSIS projects for CMS, including projects to help the agency improve the quality of managed care encounter data submitted by the states. Page 2

3 Specifically, Truven Health can support states in delivering the new T-MSIS extracts by: Designing and developing new extracts. We can help the agencies ensure that the data required for T-MSIS is captured and stored according to CMS specifications. CMS has expanded the field list from approximately 400 fields to more than 1,000 to support more comprehensive and robust reporting. Plus, modifications continue to be made to the T-MSIS data dictionary. Agencies can utilize our knowledge of state program data and T-MSIS modifications to help enable efficient execution while supporting the state agency s investment and strategy. Providing monthly extracts. With T-MSIS, the frequency of updates will move from quarterly to monthly. Additionally, CMS will incorporate automatic data quality checks and provide real-time feedback to the states. Truven Health can not only support these monthly updates, but will also work with CMS to review and correct any data quality issues. Delivering outbound files to CMS. Truven Health can work with CMS (or its designated vendors) to validate and document file transmission requirements. (We will also update and maintain the specifications over the life of our contract.) Additionally, we can develop and apply data quality and validity checks for the output file, incorporating the appropriate business rules. We are also skilled at establishing submission processes with built-in controls and checks to assure complete delivery. Expanding the dataset to include eight files and additional data elements. The T-MSIS extracts will increase from five to eight files. Truven Health will provide extracts for eligibility and claims (including inpatient, longterm care, outpatient, and pharmacy) data, along with the new data requirements third-party liability provider and managed care plan. With the expanded field list and ongoing data dictionary modifications, Truven Health can work with states to evaluate any new or missing data elements. Attending CMS-sponsored teleconferences. Truven Health can attend CMS teleconferences, as available, to understand requirements, assist in defining submission criteria and to identify questions and/or issues. Developing mapping documents. The CMS data dictionary outlines data elements that will be standardized across all states for submission. Mapping documents are needed to align state program-specific data elements to these fields for complete and accurate data extract submission. We can work with the state, CMS and the current MMIS vendor (if needed) to develop mapping documents that capture the data accurately and meet CMS requirements to support consistent reporting across states. Working with the state to adjust processes and align with future changes. To accommodate future requirements and modifications, Truven Health is poised to work with states to determine the scope of work associated with these changes via strategic change management processes. Helping the state respond to T-MSIS-related federal mandates. Truven Health can help states respond to T-MSIS-related federal mandates, as appropriate. A sample of existing T-MSIS-related mandates and how we can assist a state are briefly described on the following page Page 3

4 Requirements Description Truven Health Analytics Support BBA Section 4753(a) 6402(c) 6504(a) 6504(b) 402(c) Requires states to submit electronic claims data transmission consistent with the MSIS as of 1/1/1999 Provides for withholding federal matching payments for medical assistance to states that fail to report enrollee encounter data in the Medicaid Statistical Information System (MSIS) in a timely manner Data submitted to CMS after 1/1/2010 must include the elements CMS determines necessary for program integrity, program oversight, and administration in order for the state to receive Federal Financial Participation (FFP) Mandates that a service entity provide sufficient patient encounter data to the state to identify the physician who delivers services to patients, and that the provision of such data to the state is at a frequency and level of detail to be specified by CMS Provides for improvement to the timeliness of reporting and analyzing of data related to enrollment and eligibility of children under Medicaid and CHIIP Mandates identifying, collecting, and evaluating health disparities data under Medicaid and CHIP on the basis of race, ethnicity, sex, primary language and disability status Mandates that states support the office specifically established under ACA for providing federal coverage and payment coordination for dual-eligible beneficiaries Deliver T-MSIS extracts electronically Deliver T-MSIS extracts in a timely manner, report all managed care encounter data provided by the managed care organizations (MCOs) and passed to the DSS and continue to work with the state, the MMIS contractor (if needed) and the MCOs to make continued improvements in encounter data quality and completeness Meet the current T-MSIS requirements and work with the state to meet future requirements as needed Ensure T-MSIS extracts provide sufficient patient encounter data as defined in the requirements Deliver T-MSIS extracts in a timely manner, consistent with federal requirements Ensure T-MSIS extracts contain all available data and work with the state to obtain any data elements not currently available to support T-MSIS requirements Ensure dual-eligibles are included in T-MSIS extracts as defined in the requirements Get connected Call , stategov@truvenhealth.com or visit truvenhealth.com/your_healthcare_focus/medicaid/ About IBM Watson Health business Truven Health Analytics, part of the IBM Watson Health business, provides market-leading performance improvement solutions built on data integrity, advanced analytics and domain expertise. For more than 40 years, our insights and solutions have been providing hospitals and clinicians, employers and health plans, state and federal government agencies, life sciences companies and policymakers, the facts they need to make confident decisions that directly affect the health and well-being of people and organizations in the US and around the world. The company was acquired by IBM in 2016 to help form a new business, Watson Health. Watson Health aspires to improve lives and give hope by delivering innovation to address the world s most pressing health challenges through data and cognitive insights. Truven Health Analytics owns some of the most trusted brands in healthcare, such as MarketScan, 100 Top Hospitals, Advantage Suite, Micromedex, Simpler and ActionOI. Truven Health has its principal offices in Ann Arbor, MI, Chicago, IL and Denver, CO. For more information, please visit truvenhealth.com Page 4

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