NCJ Number
65710
Date Published
1978
Length
62 pages
Annotation
MEDICAID MANAGEMENT INFORMATION SYSTEMS IN MICHIGAN, OHIO, AND WASHINGTON WERE REVIEWED BY THE GENERAL ACCOUNTING OFFICE (GAO). THEY ARE DESCRIBED AS UNDERDEVELOPED, UNDERUSED, AND SOMETIMES ILLEGAL.
Abstract
THESE INTEGRATED COMPUTER PROCESSING OPERATIONS ARE USED BY STATES TO PROCESS AND PAY BILLS FOR MEDICAID SERVICES, STORE AND RETRIEVE SERVICE AND PAYMENT DATA, AND GENERATE MANAGEMENT REPORTS. THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE (HEW) PAYS STATES 90 PERCENT OF THE COSTS TO DEVELOP SUCH SYSTEMS AND 75 PERCENT OF THE COST TO OPERATE THEM (INSTEAD OF THE USUAL 50 PERCENT COST SHARING). A TOTAL OF 17 STATES HAVE SYSTEMS ALTHOUGH GAO ONLY REVIEWED THE SYSTEMS OF 3 STATES. NONE OF THE THREE SYSTEMS FULLY COMPLIED WITH LEGISLATIVE OR REGULATORY REQUIREMENTS ALTHOUGH HEW HAD PREVIOUSLY APROVED THEM AS OPERATIONAL. THIS NONCOMPLIANCE STEMMED FROM WEAKNESSES IN HEW'S SYSTEM-APPROVAL PROCESS AND SYSTEM-DESIGN CRITERIA. A FUNDAMENTAL CHANGE IN FEDERAL ADMINISTRATIVE COST SHARING IS NEEDED. STATES SHOULD BE REIMBURSED FOR OPERATING A SYSTEM THAT NEEDS CERTAIN PERFORMANCE STANDARDS OF EFFICIENCY AND EFFECTIVENESS AND NOT FOR MERELY HAVING AN APPROVED SYSTEM. HEW MUST IMPROVE ITS SYSTEM DESIGN AND APPROVAL PROCESS, AND TEST AND MONITOR SYSTEMS IN OPERATION, AS WELL AS THOSE BEING PLANNED, TO ASSURE THEIR COMPLIANCE WITH LEGISLATIVE AND HEW REQUIREMENTS. HEW MUST ALSO EXERCISE FIRMER CONTROL OVER SYSTEMS' COSTS. TO ENABLE HEW TO BETTER MANAGE AND CONTROL INFORMATION SYSTEMS, CONGRESS SHOULD CONSIDER AMENDING THE LAW TO REQUIRE THAT STATES MEET PERFORMANCE STANDARDS IN ORDER TO RECEIVE EXTRA FUNDING. TWO APPENDIXES LIST STATES WITH CERTIFIED SYSTEMS AND MICHIGAN'S MEDICAID CLAIMS COST BY FUNCTION FOR FISCAL YEAR 1976. (MJW)