Medicaid Research Support Tools Gerri Barosso, RD, MPH, MS Technical Advisor University of Minnesota
Overview Available resources and where to find them: ˗ Medicaid program description ˗ State coverage and plan information ˗ State Drug utilization files ˗ Managed Care participation rates ˗ Medicaid statistics ˗ Data support on the CMS web site: » FAQ for MAX files » Data Anomalies Database » Data Validation tables ˗ Additional Non-CMS resources New MAX data files URLs on the section handout 2
Medicaid Program NATIONAL CMS/Medicaid.gov ˗ Program information by topic ˗ Eligibility, benefits, cost sharing, etc. House Ways and Means Committee ˗ Green Book, Ch 15, 2003, published 2004 ˗ Increasing level of detail ˗ Medicaid disappears in the 2008 book Kaiser Family Foundation ˗ Medicaid Resource Book » Last updated July 2002 » Detailed explanation of aspects of program, include index ˗ Medicaid Primer » Latest June, 2010 » Historical Dec 2008, Mar 2007, July 2005 3
Medicaid Program NATIONAL (CONT) Kaiser Family Foundation ˗ “Medicaid Resource Book” Many reports on duals, Medicare, SCHIP ˗ Urban Institute ˗ analyses of proposed/implemented programs on a variety of issues National Pharmaceutical Council ˗ Annual publication on state prescription drug benefits ˗ State contacts specific to drug benefit ˗ 1963-2005, 2007 National Academy for State Health Policy ˗ Current initiatives, recent program changes 4
State-Specific Program Information Medicaid waiver information ˗ Medicaid.gov web site » overview of waiver types » access to brief descriptions of state-specific waivers State Medicaid plans ˗ Kaiser Family Foundation » Review within state or across states » Jan 2003, Oct 2004 , Oct 2006 and Oct 2008 » Source: documents submitted to CMS Some state Medicaid agency sites 5
State-specific MANAGED CARE PARTICIPATION CMS MCO enrollment statistics ˗ Current: July 1, 2010 ˗ Note: not a calendar year, not a federal fiscal year » Trend table 2000 to 2009 » State penetration rates July, 2010 » Definitions included in National Summary Report ˗ Utility » Descriptions of plans » Enrollment by plan by county » Assess amount of data available » Percent of MA population likely to have FFS claims » Dual eligible MCO enrollment 6
State-specific MCO PROGRAM DESCRIPTIONS Descriptions of state MCO programs ˗ June 30, 2009 ˗ Services covered by specific MCO programs ˗ Types of professionals qualified to be primary care providers ˗ Voluntary or mandatory enrollment by eligibility group, excluded groups 7
Managed Care Participation Example of need for enrollment by plan type: 8
Managed Care Participation 9
Managed Care Participation 10
Managed Care Participation Alternative to assess effect on data in MAX files ˗ Data Validation Table Excel Workbook » Currently available MAX data years » Download from CMS web site ˗ PS file spreadsheet » Enrollment - Anytime during calendar year » By aggregated eligibility group (aged, disabled, child, adult) » OR…By type of managed care (HMO/HIO, dental, etc) - In June of calendar year of MAX file » Ever enrolled by aggregated eligibility groups 11
Medicaid Statistics All sources ˗ No geography smaller than state ˗ Enrollment, expenditures , utilization by broad type of service ˗ No diagnosis or procedure level data Highlights: ˗ MAX chartbooks, 2002, 2004, 2008 data ˗ CMS Medicare/Medicaid Statistical Supplement » Some trend tables 1975-2009 ˗ Medicaid Prescription Utilization, 1999, 2001-2008 » Reporting by 18 broad therapeutic classes » Some tables in Excel format ˗ MSIS data tables, 1999-2009 » Anomalies information included Kaiser Family Foundation: State Medicaid Fact Sheets ˗ » Create custom comparisons, eg: national: to state, state: to state » Export as .pdf 12
Medicaid Statistics MSIS DATA MART MSIS Data Mart ˗ Generally same variables as MSIS statistics site » Create crosstabs, nested rows/columns ˗ Register as a user for access ˗ Need to understand variable definitions ˗ Create tables using COGNOS Powerplay ˗ FFY 2010, 32 states , access 08-07-2012 ˗ MSIS Data Anomalies report is included ˗ Recommend using Internet Explorer vs Mozilla/Firefox or Safari 13
Medicaid Statistics MSIS DATA MART 14
Medicaid Data STATE DRUG UTILIZATION FILES Downloadable data files FFY1991-2011 Q4, by state, quarter, NDC code ˗ May vary by state, as is distribution Zipped files, extract to text format Read into Access, SAS, SPSS Utility ˗ Determine frequency of use, power for analyses ˗ Background statistics for grant proposals » Trend data, regional comparisons 15
State Drug Utilization Files 16
NDC Information FDA ˗ Smaller number of codes ˗ May not be as current ˗ Therapeutic class no longer maintained Commercial products such as ˗ First Data Bank ˗ Wolters Kluwer Medi-Span Any other resources? 17
MAX Data Support Resources MAX Data Documentation ˗ Variable crosswalk tables, additions, deletions ˗ Data Validation Tables » Pre-acquisition to select states, anticipate utility of MAX » Post-acquisition to check results » Background stats for grant proposals: enrollment, MCO, Duals, utilization, payments, charges » Measure calculation methodology now available ˗ Data Anomalies Database » Noted during MAX production » Issues in code mapping, limited number of values for variables such as procedure or dx codes, unexplained variation across years » General plus state- and file-specific 18
MAX Data Support Resources ANALYTIC GUIDANCE REPORTS Buccaneer, CMS data distribution contractor ˗ Max Data User Guide ˗ Getting Started with MAX Data Files ˗ Options in Determining Dual Eligibles 19
MAX Data Support Resources MSIS DOCUMENTATION MSIS data dictionary ˗ Documentation on the source of MAX data ˗ Some useful detail » ATTACHMENT 3 - Comprehensive Eligibility Crosswalk - Includes details of subgroups, the federal code or public law citation for the coverage » ATTACHMENT 4 - Types of Service Reference - As defined by the Code of Federal Regulation » ATTACHMENT 5 – Program Type References 20
MAX data Support Resources MEDICAID ISSUE BRIEFS Analysis of MAX data or anticipation of program change effects Current briefs include: ˗ Enrollee changes anticipated in 2014 ˗ Patterns in enrollment of children ˗ Medicaid managed care and long term care ˗ Movement of children from Medicaid to CHIP ˗ Usability of MAX 2007 IP/RX Encounter data ˗ Enrollment gaps ˗ Prescription drug use 21
MAX Data Support Resources ENVIROMENTAL SCANNING AND PROGRAM CHARACTERISTICS Medicaid and CHIP program characteristics ˗ Centralized source ˗ Information gathered from many of those resources presented here » Eligibility criteria, waivers, managed care, benefits, reimbursement » 1394 variables included » Data user guide and examples Downloadable Current version 2005 data onward Next update in CY 2013 22
MAX Data Support Resources MAX PROVIDER CHARACTERISTICS FILE MAX traditionally included only state provider IDs NPI added in MAX 2009 MAXPC available for 37 or 51 jurisdictions ˗ Downloadable ˗ Variables include: NPI, legacy IDs, name/address, creditionals, national specialty taxonomy code, counts of claims by provider, counts of beneficiaries by provider ˗ Documentation includes data dictionaries, validation tables and anomalies 23
MAX Data BEYOND TRADITIONAL CLAIMS/ENROLLMENT MAX Date of Death ˗ DOD generally poorly reported via MSIS to MAX PS ˗ SSA Death Master File DOD » Added to MAX PS beginning MAX 2007 » Dates through Dec 31 st of MAX file year MAX Date of Death Auxiliary File ˗ Released as a “current” file ˗ Now available: DODs for those enrolled 1999 through 2008 ˗ DODs current through Oct 29, 2011 ˗ Linked to MAX via Bene_ID 24
MAX Data BEYOND TRADITIONAL CLAIMS/ENROLLMENT (CONT) Mini-MAX ˗ National 5%, cross-sectional sample Stratified by state and eligibility group ˗ ˗ Oversamples smaller states and subpopulations ˗ Removed some MAX variables to reduce file size CMS documentation includes a user guide ˗ Details of file development ˗ Analysis considerations Availability ˗ Currently for CY 2008 via the Research Identifiable File request process Buccaneer record layouts pending ˗ 25
ResDAC Data Assistance ResDAC web site ˗ Data documentation links ˗ CMS data release policy updates ˗ Data request documents ˗ Updates on data availability One-on-one assistance ˗ 888.973.7322 ˗ resdac@umn.edu 26
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