Transformed Medicaid Statistical Information System

T-MSIS has undergone functional enhancements, added/updated data sharing methods (all with internal CMS partners), and updated technologies for security and performance since the last PIA review. None of the changes indicated PIA impact. There has not been a change to the way data is collected, used or stored. All sharing of PII is conducted with internal CMS partners.   The following is a summary of changes:

Internal interconnection from CMS Cloud/AWS Redshift to AWS SAS Viya.
Updated data processing and sharing method with MACBIS Data Warehouse (DataConnect).
T-MSIS internal data processing functions and methods.
Implementation of Containerization (Docker) deployment for existing T-MSIS processes.
Vertical scaling of compute and storage instances.
Internal interconnection via T-MSIS S3 access by IDR (CMS system).
Internal connection to MACBIS Data Warehouse S3 bucket for aggregated Medicare/Medicaid Modernization Act (MMA) data.

Transformed Medicaid Statistical Information System (T-MSIS) is the system that receives and processes Medicaid eligibility and claims data that State Medicaid agencies submit to CMS as a result of the Balanced Budget Act (BBA) of 1997.

T-MSIS is a critical component of achieving the Medicaid and Children’s Health Insurance Program (CHIP) Business Information Solution (MACBIS) goals. The goal of T-MSIS is to collect a baseline set of data and to use a common expandable and sustainable platform towards a CMS Medicaid and CHIP Business Information Solution system.

T-MSIS is used to reduce State burdens currently impacted by multiple CMS requests for data, and to better enable States to perform their core responsibilities of Medicaid and CHIP program oversight, administration, and program integrity.

T-MSIS contains the minimum required data elements obtained from 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. These file extracts are submitted on a monthly basis in the form of electronic file transfers to CMS. The file extracts submitted by the States consist of 8 file types: 1) Eligibles, 2) Providers, 3) Managed care organizations, 4) Third Party Liability obligations, and 5-8) four types of Claims (Prescription, Long Term Care, Inpatient, and Other).

Personally identifiable information (PII), including Protected Health Information (PHI) is submitted to CMS by the States via Secure Electronic File Transfer and from the MACBIS Data Warehouse System (which has its own PIA) via direct S3 access points. The PII includes: the assigned Medicaid identification number; Social Security Number; Health Insurance Claim Number; Date of Birth; sex; ethnicity and race; 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 assigned provider identification number, information used to determine whether a sanction or suspension is warranted and data related to the Medicare/Medicaid Modernization Act (MMA).

T-MSIS does not collect, process or store user credentials for its end users; rather, identification, authentication and authorization for access to T-MSIS is performed by the CMS Identity Management (IDM) access control software, which transmits information about authorized user identity, roles, and accesses via integration with the CMS Enterprise Portal.

T-MSIS does collect, process, and store user credentials for a limited number Direct Contractors involved in back-end system support, administration, and operations roles.

The information collected and stored for these administrative users consist 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, T-MSIS records user activity within the T-MSIS system for audit purposes, and stores the user identifier associated with a user’s actions in the T-MSIS audit logs.

The primary purpose of T-MSIS is to establish an accurate, current, and comprehensive database containing standardized enrollment, eligibility, and paid claims of Medicaid beneficiaries to be used for the administration of Medicaid at the federal level, produce statistical reports, support Medicaid related research, and assist in the detection of fraud and abuse in the Medicaid program.  Information in this system will also be used to support regulatory and policy functions performed within the agency or by a contractor or consultant, another federal or state agency, agency of a state government, an agency established by state law, or its fiscal agent, support research of policy issues, quality and effectiveness of care, and of epidemiological projects, support constituent requests made to a congressional representative, support litigation involving the agency related to this system of records, and combat fraud and abuse in certain federally funded health care programs. The PII includes: the assigned Medicaid identification number; Social Security Number; Health Insurance Claim Number; Date of Birth; sex; ethnicity and race; medical services; equipment information; supplies for which Medicaid reimbursement is requested; and materials used to determine amount of benefits allowable under Medicaid. T-MSIS uses a unique identifier referred to as the MSIS Identifier. Records can be retrieved using this data element. In states that use Social Security Number (SSN) as their MSIS Identifier, records can be retrieved by SSN. The records are kept for 5 years and then destroyed.

The T-MSIS application captures information about its users’ activities within the T-MSIS system in audit logs for the purpose of ensuring system usage in accordance with rules of behavior, managing system operations, and ensuring confidentiality, integrity, and availability of its data. This auditing process collects the user identifiers (not including credentials) of authenticated users who are active in the system and logs details of user activity in the system. The audit logs are retained and managed on a retention schedule in accordance with the current CMS Information Systems Security and Privacy Policy (IS2P2). 

• Social Security Number
• Name
• E-Mail Address
• Phone Numbers
• Date of Birth
• Mailing Address
• Other - Race/Ethnicity, Health insurance claim number (HICN), Unique Physician Identification Number (UPIN), sex, citizenship/immigration status, user identifiers

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

The primary purpose of the PII used by T-MSIS is to support the mission of providing health benefits and services to beneficiaries of the Medicaid and Children's Health Insurance Program (CHIP) programs in accordance with Federal statutes or regulations.

Included in the scope of this activity is maintaining PII/PHI necessary to support continued operations and oversight of the Medicaid and Children's Health Insurance Program (CHIP) programs, including information used to prevent, detect, identify, and address fraud, waste, and abuse in such programs.

T-MSIS does not collect PII or PHI directly from the individual. Rather, T-MSIS receives PII/PHI from the States. It is the responsibility of the states, or their data sources, to have a notice of privacy practices that states the primary purpose of collecting and using the PII. T-MSIS is designed to help states improve their data quality. T-MSIS runs analytics on the data including PII to detect anomalies indicative of poor data quality (e.g., if a person had a medical treatment after the date of their death) so that CMS can work with states to improve their data.

User credential information for direct contractor system administrators is collected to control system access.

User identifier information for all system users is captured in the T-MSIS audit logs to ensure user activity in the system is in accordance with rules of behavior, support overall system operations activities (such as isolation of technical issues), and protect confidentiality, integrity, and availability of the system’s data.

User identifier information is disclosed only to direct contractors involved in support of these activities and CMS employees overseeing these activities and/or identified as having security and privacy responsibilities requiring access to this information.

09-70-0541

Medicaid Statistical Information System

Medicaid Statistical Information System (MSIS) and the Transformed - Medicaid Statistical Information System (T-MSIS):

OMB# 0938-0345

Expiration Date: 11/30/2027

Within HHS Explanation: Within the Operating Division

Users are typically business owners and program staff who evaluate and report on the Medicaid and Children's Health Insurance Program (CHIP) programs.

Not applicable. The notification is the responsibility of the State/Local/Tribal government sources of the data.

For user credential information, notification is the responsibility of the organization responsible for the access control system which issues the original user credentials.

Centers for Medicare and Medicaid Services (CMS) has a continuous monitoring program based on the National Institutes 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 T-MSIS System Security Plan (SSP) and within the CMS FISMA Controls Tracking System (CFACTS) for T-MSIS. 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: Users are typically business owners and program staff who evaluate and report on the Medicaid program.
• Administrators: Administrators are those charged with maintaining the database on the mainframe and mid-tier platforms.
• Developers: Developers gather the business rules and apply them to the systematic process of storage and manipulation.
• Contractors: Contractors also gather the business rules and apply them to the systematic process of storage and manipulation. The Contractors are direct contractors for HHS.
• Others: Some users need PII in order to link T-MSIS data to data from other systems (e.g., Medicare for analysis of dual Medicaid/Medicare enrollees).

T-MSIS follows the National Archives and Records Administration (NARA) General Records Schedule (GRS) 3.1 - General Technology Management Records (DAA-GRS-2013-0005-0004), for retention and destruction of user credential information captured in system audit logs. T-MSIS retains audit records for a minimum of ninety (90) days and archives old records for a minimum of one (1) year 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). This general CMS records schedule is sub-divided into collections of related records types, known as Buckets.

T-MSIS follows the following CMS Records Schedules: Bucket 5 (Beneficiary Records) for information on eligible beneficiaries and related information involving the Medicaid and Children’ Health Insurance Program (CHIP) programs.

CMS retains identifiable data for a total period not to exceed 10 years after the final determination of the case is completed. All claims-related records are encompassed by the document preservation order and are retained until notification is received from Department of Justice (DOJ).