CMS-64 Quarterly Expense Report

Form CMS-64 is a statement of expenditures for which states are entitled to federal reimbursement under Title XIX of the Social Security Act. It reconciles the monetary advance made on the basis of Form CMS-37, filed previously for the same quarter. Consequently, the amount claimed on Form CMS-64 is a summary of expenditures derived from source documents, such as invoices, cost reports, and eligibility records. At the workshop, David Rousseau made the point that the CMS-64 is primarily collected to reconcile payments to states from the federal treasury for services delivered to Medicaid beneficiaries. It has a great deal of information about overall spending but not very much about what is driving that growth, because, he pointed out, there is no information on utilization, enrollment, or the types of beneficiaries that use that service, and managed care spending is not separated into the services.

Medicaid Statistical Information System

The purpose of the Medcaid Statistical Information System (MSIS) is to collect, manage, analyze, and disseminate information on eligibles, beneficiaries, utilization, and payment for services covered by state Medicaid programs (see [September 2010]). The MSIS data serve multiple purposes, including health care research and evaluation activities, program utilization and expenditures forecasting, analyses of policy alternatives, responses to congressional inquiries, and matches to other health-related databases. States provide CMS with quarterly computer files containing, among other data items, specified data elements for persons covered by Medicaid (eligible files). If a person is covered by Medicaid (or CHIP) for at least 1 day during the reporting quarter, their demographic and monthly enrollment data resides in this file. Claims records contain information on the types of services provided, providers of services, service dates, costs, types of reimbursement, and epidemiological variables. The data files are subjected to quality assurance edits to ensure that the data are within acceptable error tolerances, and a distributional review verifies the reasonableness of the data. Once accepted, valid tape files are created that serve as the historical source of detailed Medicaid eligibility and paid claims data maintained by CMS.

Statistical Enrollment Data System

States submit quarterly and annual CHIP statistical data to CMS through the SEDS automated reporting system (U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, 2010, p. 47). Using forms provided by CMS, states report unduplicated

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