Medicaid and CHIP DataConnect

The Medicaid and CHIP (Children's Health Insurance Program) DataConnect (MAC-DC) system supports the analysis of Medicaid eligibility and claims data that State Medicaid agencies submit to Centers for Medicare & Medicaid Services (CMS) as a result of the Balanced Budget Act (BBA) of 1997.

The primary function of Medicaid and CHIP DataConnect is to integrate data to accommodate CMS business and analytic needs to provide timely, accurate information in the support of Center for Medicaid and CHIP Services (CMCS) program oversight functions and other CMS business needs that utilize Medicaid and Children's Health Insurance Program (CHIP) data.

Medicaid and CHIP DataConnect supports its primary function through a unified analytic platform that ensures data sourced from MAC-DC systems are integrated appropriately to support analysis of evolving health care delivery reforms, access to coverage, and to enable proper monitoring and oversight. Aside from data needed to support the multi-billion dollar waiver negotiations, CMS will use MAC-DC data for program integrity, evaluation of demonstrations, actuarial analysis, quality of care analysis, and to share this rich data set with states, stakeholders, and the research community.

Personally Identifiable Information (PII) data is collected/provided to Medicaid and CHIP DataConnect via the T-MSIS FISMA System, which is covered by its own PIA. Medicaid and CHIP DataConnect processes and maintains this data for research analysis and reporting.

The PII/Protected Health Information (PHI) used by Medicaid and CHIP DataConnect includes: the assigned Medicaid records number; social security number; health insurance claim number; date of birth; phone number; citizenship/immigration status; sex; ethnicity and race; mailing address; medical services; equipment information; supplies for which Medicaid reimbursement is requested; and materials used to determine amount of benefits allowable under Medicaid.

The system also collects information on physicians and other providers of services to the beneficiary consisting of an assigned provider identification number, and information used to determine whether a sanction or suspension is warranted.

The Medicaid and CHIP DataConnect system collects, processes, and stores user credentials for a limited number of direct contractors who are involved in system support, administration, and operations roles. The information collected and stored for these administrative users consists of the direct contractor’s name, user identifier, and business e-mail address. These user identifiers are assigned to the user via the CMS Enterprise User Management (EUA) access control software for all users. EUA is covered by its own PIA.  Medicaid and CHIP DataConnect records user activity within the data warehouse system for audit purposes and stores the user identifier associated with a user’s actions in the Medicaid and CHIP DataConnect audit logs.

Information (to include PII/PHI & user credentials) is currently retained for 7 years in accordance with defined frequency and National Archives and Records Administration (NARA) retention schedules.

Medicaid and CHIP DataConnect is an analytics and reporting system that maintains and shares the minimum required data elements (obtained from T- MSIS via individual states) necessary to support administration of the Medicaid program at the federal level, Medicaid-related research of policy issues, quality, and effectiveness of care, and to combat fraud.

Information is maintained and shared temporarily, as information is retained for 7 years in accordance with defined frequency and NARA retention schedules. Information necessary to support the function of this system is as follows:

Medicaid records number; social security number; health insurance claim number; date of birth; sex; ethnicity and race; mailing address; phone number; citizenship/immigration status; medical services; equipment information; supplies for which Medicaid reimbursement is requested; materials used to determine amount of benefits allowable under Medicaid, direct contractor’s name, user identifier, and business e-mail address.

• Social Security Number
• Name
• E-Mail Address
• Phone Numbers
• Date of Birth
• Mailing Address
• Medical Records Number
• Other - Other - Race/Ethnicity, Health insurance claim number (HICN), Unique Physician Identification Number (UPIN), sex, citizenship/immigration status, medical services, user credentials, and information used to determine whether a sanction or suspension is warranted.

• Employees
• Public Citizens
• Other - Other - Medicaid/CHIP beneficiaries (and/or individuals eligible for benefits), PROVIDERS

Medicaid and CHIP DataConnect does not directly collect any data covered under a SORN.

For specifics on each set of ingested data, the individual sourcing system’s SORN should be consulted for details (T-MSIS SORN: 09-70-0541).

• Within HHS
• Other Federal Agency/Agencies
• State or Local Agency/Agencies

Medicaid and CHIP DataConnect requires all non- organizational individuals to have a valid Data Use Agreements (DUA) in place to receive access to Medicaid and CHIP DataConnect data. The DUA does not allow sharing or disclosure of information outside of the individuals or parties named in the agreement, unless specifically authorized in writing.

Medicaid and CHIP DataConnect has no Memorandum of Understanding (MOU) in place with external organizations as Medicaid and CHIP DataConnect does not currently support direct access to data by local/state and federal agencies. An exception to this is the Information Sharing Agreement (ISA) currently in place with the Health and Human Services (HHS) Office of the Inspector General (OIG).

An Information Sharing Agreement (ISA) is currently in place with the Health and Human Services (HHS) Office of the Inspector General (OIG), including the Health Insurance Portability and Accountability Act (HIPAA) disclosure policy 45 Code of Federal Regulations (CFR) 164.528.

In order to document the sharing and disclosures of data, requests must come in writing via email to the Centers for Medicaid and CHIP Services (CMCS) Director.

Not Applicable. Information is provided to Medicaid and CHIP DataConnect via the T-MSIS FISMA System.

Notification is provided at the State/Local/Tribal government level as that is where information collection occurs. Notification of collection for PII/ PHI is covered in the T-MSIS PIA.

Not Applicable. Information is provided to Medicaid and CHIP DataConnect via the T-MSIS FISMA System.

Collection is provided at the State/Local/Tribal government level. Individuals are given the opportunity to opt-out at the State/Local/Tribal government level at the time of information collection. Opt-out for collection of PII/PHI is covered in the T-MSIS PIA

Centers for Medicare and Medicaid Services (CMS) has a continuous monitoring program based on the National Institute of Science and Technology (NIST) recommendations to ensure system integrity, availability & confidentiality. This includes general processes, policies, and procedures defined under the CMS Information Systems Security and Privacy Policy (IS2P2), and specific security and privacy control implementations documented in the Medicaid and CHIP DataConnect System Security Plan (SSP) and within the CMS FISMA Controls Tracking System (CFACTS) for MAC-DC. The individual enrollment application is designed with logic checks to ensure data accuracy and integrity.

Centers for Medicare and Medicaid Services (CMS)/Center for Consumer Information and Insurance Oversight (CCIIO) has established an Enrollment Resolution and Reconciliation program to provide services necessary to resolve errors and reconcile discrepancies in enrollment data between the Health Insurance Exchange, State Based Marketplaces, issuer community, and CMS.

Yearly, CCIIO is required to review and update the enrollment process to ensure data collected is relevant to the health insurance enrollment process.

• Users: Medicaid and CHIP DataConnect does not itself have front end users, access to the system's information is gained through connected Business Intelligence tools. Users are typically business owners and program staff who evaluate and report on the Medicaid program. PII is granted to this category of individual to assist with analytics, research, and reporting. Additionally, in some cases to link Medicaid and CHIP DataConnect data to data from other systems (e.g., Medicare for analysis of dual Medicaid/Medicare enrollees). PII/PHI this category can access: the assigned Medicaid records number; social security number; health insurance claim number; date of birth; sex; ethnicity and race; mailing address; medical services; equipment information; supplies for which Medicaid reimbursement is requested; and materials used to determine amount of benefits allowable under Medicaid. Information on physicians and other providers of services to the beneficiary consists of an assigned provider identification number, and information used to determine whether a sanction or suspension is warranted.
• Administrators: Administrators are those charged with maintaining the database. PII/PHI this category can access to perform job duties: 
  the assigned Medicaid records number; social security number; health insurance claim number; date of birth; sex; ethnicity and race; mailing address; medical services; equipment information; supplies for which Medicaid reimbursement is requested; and materials used to determine amount of benefits allowable under Medicaid. Information on physicians and other providers of services to the beneficiary consists of an assigned provider identification number, information used to determine whether a sanction or suspension is warranted, direct contractor’s name, user identifier, and business e-mail address.
• Developers: Developers gather the business rules and apply them to the systematic process of storage and manipulation. PII/PHI this category can access to perform job requirements: the assigned Medicaid records number; social security number; health insurance claim number; date of birth; sex; ethnicity and race; mailing address; medical services; equipment information; supplies for which Medicaid reimbursement is requested; and materials used to determine amount of benefits allowable under Medicaid. Information on physicians and other providers of services to the beneficiary consists of an assigned provider identification number, and information used to determine whether a sanction or suspension is warranted
• Contractors: Direct contractors also gather the business rules and apply them to the systematic process of storage and manipulation. PII/PHI this category can access: the assigned Medicaid records number; social security number; health insurance claim number; date of birth; sex; ethnicity and race; mailing address; medical services; equipment information; supplies for which Medicaid reimbursement is requested; and materials used to determine amount of benefits allowable under Medicaid. Information on physicians and other providers of services to the beneficiary consists of an assigned provider identification number, and information used to determine whether a sanction or suspension is warranted.

Internal administrative and data science accounts are provided only to people working on Medicaid and CHIP DataConnect with CMS IDs who have a business need to use one of those accounts. Role based access control is implemented to contain access to PII and PHI to only those roles required to view based on the principles of least privilege. Users may request additional role(s) based on job needs.

Medicaid and CHIP DataConnect administrators are required to review and approve those requests based on user need and job requirements.

Medicaid and CHIP DataConnect follows the National Archives and Records Administration (NARA) General Records Schedule (GRS) 3.1 - General Technology Management Records (disposition DAA-GRS-2013-0005-0004); item 20, for retention and destruction of user credential information captured in system audit logs. This has a retention period of temporary. Medicaid and CHIP DataConnect retains audit records for a minimum of ninety (90) days and archives old records for a minimum of one (1) year to destroy three (3) years after agreement control measures, procedures, project, activity, or transaction is obsolete, completed, terminated or superseded, but longer retention is authorized if required for business use to provide support for after-the-fact investigations of security incidents and to meet regulatory and CMS information retention requirements.

The Medicaid and CHIP program information follows the standard CMS Records Schedules (DAA-0440-2015-0007). DAA-0440-2015-0007 refers to the CMS bucket schedule Bucket 5: Beneficiary Records; sub-bucket 5: beneficiary records.

Medicaid and CHIP DataConnect follows the following CMS Records Schedules: sub-bucket 5 (Beneficiary Records) for information on eligible beneficiaries and related information involving the Medicaid and Children's Health Insurance Program (CHIP) programs. This has a retention period of destroy no sooner than 10 year(s) after cutoff but longer retention is authorized.