Introduction to CMS Medicaid Enrollment and Utilization Data Files - - PowerPoint PPT Presentation

Introduction to CMS Medicaid Enrollment and Utilization Data Files

Gerri Barosso, ResDAC Technical Advisor

About ResDAC

• Centers for Medicare and Medicaid Services (CMS)

contractor

• Offer free assistance to researchers interested in

using Medicare and Medicaid data for research

• Staffed by a team of public health and health

services research specialists

• Provide data user support

˗ Individual assistance via email, web, phone ˗ Education and training via workshops and webinars

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CMS Medicaid Research Files

• Medicaid Enrollment and Utilization files

˗ Medicaid Analytic eXtract Files (MAX) ˗ Focus on full MAX ˗ Introduce Beta-MAX and Mini-MAX

• Introduce three supplemental MAX files
• Highlight some resources for MAX data users
• A recording of this webinar, the transcript and the

PowerPoint slides will become available on the ResDAC website.

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CMS MAX Files

• Medicaid Analytic eXtract or MAX

˗ Only available as Research Identifiable Files ˗ Data requests for studies that meets CMS criteria for research

» Release governed by the Privacy Act of 1974 and HIPAA » Information on the process on the ResDAC website:

• ResDAC Data Request Center
• ResDAC webinars on the request process

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Creation of MAX files

• Production dependent on files submitted by states

˗ Medicaid Statistical Information System (MSIS) ˗ Sole input data for MAX ˗ Seven quarters to creation of standard MAX files

• MAX modifies MSIS data for ease of research

˗ Final Action processing, edits, validation tests ˗ Record organization suited to research: calendar year of enrollment and service ˗ As released by the CCW, the Beneficiary ID facilitates linkage across years and across MAX and Medicare files

• Five file types per state per year of data

˗ Personal Summary, Inpatient, Long Term Care, Prescription Drug and Other Therapy

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MAX Personal Summary File

• MAX PS
• Eligibility and enrollment

˗ Record for each person enrolled for at least one month,

• r who had a Medicaid paid service in the year

˗ Demographics, date of birth, county, state, zip code, date of death, flags for Medicare/Medicaid dual eligibility ˗ Summary of charges and Medicaid payments by board type of service categories ˗ No diagnosis or specific procedure information

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MAX Inpatient File

• MAX IP
• Acute hospitals

˗ Stay record file

» One, final action record per hospital stay » Credits and adjustment claims have been applied

˗ Up to 10 diagnosis codes

» ICD-9

˗ Principal procedure code and up to 5 additional

» CPT-4, ICD-9, HCPCS or state-specific

˗ Billing Institution NPI included for 2009 forward

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MAX Long Term Care File

• MAX LT
• Includes records for institutional long term care

stays

˗ Mental Hospital Services For The Aged ˗ Inpatient Psychiatric Facility For Individuals Under The Age Of 21 ˗ Intermediate Care Facility For The Mentally Handicapped ˗ Nursing Facility Services

• Diagnosis codes occur up to five times

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MAX Prescription Drug File

• MAX RX
• One record for each prescription fill
• Identified by National Drug Code (NDC)

˗ Prescription Drugs ˗ Over The Counter Drugs assigned an NDC ˗ Durable Medical Equipment and Supplies identified by NDC

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MAX Other Therapy File

• MAX OT

˗ Wide range of services including: physician, dental and

• ther professional services, hospital outpatient facility

claims, home health, hospice, personal care and transportation ˗ NPI should be provider who treated patient; billing provider is given as a state code ˗ Diagnosis codes occur up to two times ˗ Procedure codes occurs once ˗ Includes coding to flag community-based long term care

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MAX Supplemental Files

• Files that support research with MAX data

˗ MAX Date of Death file, MAX DOD

» Calendar year “ever” files, Research Identifiable File » Eligibles from 1999 through calendar year of file » Available SSN linked to SSA Death Master file » Dates of death more current than CY MAX PS

– Eg: MAX DOD 2008 included deaths through Oct 29, 2011

˗ MAX Provider Characteristics file, MAXPC

» Provider file, first available for 2009, includes NPIs, legacy state IDs, number of claims per provider; downloadable

˗ MAX Environmental Scanning and Program Characteristics, MAX ESPC

» By state: large number of variables including Medicaid/CHIP benefits, managed care, expenditures; from publically available data bases; downloadable » Example output, report on CMS website

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Alternative format MAX files

• Same five file types, same record layouts as Full MAX
• CMS’s goal to create early release version of MAX
• Important differences

˗ Generally fewer than 7 quarters of MSIS data ˗ State program business rules/Type of Service crosswalks are from the previous year ˗ Missing services, eligibles ˗ Quarters by state and file for each year of production ˗ Not available for all states

• Ability to study some research questions limited
• Important to review CMS documentation
• Despite best efforts, Beta-MAX may not be available for

researchers external to CMS or available only several months before full MAX

Beta-MAX

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Alternate Format MAX file (cont)

• National cross-sectional sample

˗ Stratified by state, basis of eligibility ˗ Oversample smaller states and sub populations ˗ Sample size of about 3 million

• Different record layout, fewer variables than full

MAX

• CMS Mini-MAX User Guide

˗ Understand sampling, guidance on research applications

• Current file is 2008, 2009 pending

Mini-MAX

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MAX data resources

• Data dictionaries for all files

» Variable values, user notes, detailed description of file creation

• Created final production for MAX, Beta-MAX,

MAXPC

» Data validation tables

• Excel workbook for each state, each year, spreadsheet

included for each file type

» Data anomalies report

• Claims and eligibility reports

» Useful prior to request to assess data quality and quantity » While working with the data to assess analytic results

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(MAX data resources –cont)

• CMS reports

˗ Issue briefs ˗ Design and implementation reports for MAXPC, Beta- and Mini-MAX ˗ CMS Medicaid Data webpage

• Other analytic support from the Chronic Conditions

Warehouse

˗ MAX User Guide ˗ Technical Guidance: Getting Started with MAX Data Files ˗ Chronic Conditions Warehouse, the CMS data distributor

• ResDAC website

˗ Data dictionaries ˗ Webinars, workshop videos ˗ Request process ˗ ResDAC home page

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