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Connecting States to Medicare Data

When we held our 2014 IAP listening sessions to identify possible areas of technical support for states, we heard repeatedly from Medicaid agencies that targeted technical support with getting access to and integrating Medicare-Medicaid data was greatly needed. At CMS, the Medicare-Medicaid Coordination Office (MMCO) had been working with states participating in the Financial Alignment Initiative (FAI) to support them in accessing and using Medicare data to improve program integrity and care coordination for their dually-eligible beneficiaries. Knowing that non-FAI states also needed this type of technical support, IAP and MMCO agreed that by collaborating in this area we could leverage MMCO’s experience in providing this type of support to states and use IAP resources effectively.

In September 2015, IAP selected six states to receive direct technical support from FEI Systems, Inc. for their Medicare-Medicaid data integration activities. Over the past 10 months, we have worked with Alabama, District of Columbia, Pennsylvania, New Hampshire, New Jersey, and Tennessee to move them towards a place where they would: (1) have the Medicare data they needed in order to clean and incorporate Medicare dually-eligible data into their own information systems; and (2) create a comprehensive beneficiary profile for their dually-eligible beneficiaries. As part of this work, states also receive support with getting access to additional Medicare Part A and B service claims, Part D prescription drug event data, assessment data, and Medicare crosswalk files. Further, FEI Systems, Inc.  develops generic use cases that participating states can use to better understand how to work with Medicare data. All of these activities are designed to enable states to increase their capacity to use these data for improved care delivery and care coordination.

In reflecting back over the past several months of working with these states, we found that direct access to a contractor promoted a better understanding by state teams about the steps of data acquisition. However, states still struggled with a learning curve of how to use Medicare data along with the processes and platforms needed to integrate these Medicare-Medicaid data. States that moved the furthest in the past 10 months have a dedicated champion to get this work off the ground and to help move past the learning curve of understanding how to use Medicare data.

For states that want to better understand which types of Medicare data are available, we urge you to visit MMCO’s State Data Resource Center (SDRC). On the SDRC website, states can access resources such as:

  • Descriptions of the types of Medicare data available to state Medicaid Agencies;
  • Assistance with requesting Medicare data from CMS, including outlines of the process for requesting Medicare data; and
  • Assistance with using Medicare data for Medicare-Medicaid care coordination or program integrity activities.

Based on the positive feedback from many of the participating states, IAP plans to offer additional states direct technical support in this area in late fall 2016.

IAP Commentary
Wendy Alexander, Technical Director, Medicare-Medicaid Coordination Office and Karen LLanos, Director, Medicaid IAP


Collections: IAP Commentary