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 2
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. 3
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 4
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 5
MAX Personal Summary File MAX PS Eligibility and enrollment ˗ Record for each person enrolled for at least one month, or 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 6
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 7
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 8
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 9
MAX Other Therapy File MAX OT ˗ Wide range of services including: physician, dental and other 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 10
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 11
Alternative format MAX files Beta-MAX 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 12
Alternate Format MAX file (cont) Mini-MAX 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 13
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 14
(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 15
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