Medicaid Research Support Tools Gerri Barosso, RD, MPH, MS - - PowerPoint PPT Presentation

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Medicaid Research Support Tools Gerri Barosso, RD, MPH, MS - - PowerPoint PPT Presentation

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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

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Medicaid Research Support Tools

Gerri Barosso, RD, MPH, MS Technical Advisor University of Minnesota

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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

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Medicaid Program

  • 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

NATIONAL

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Medicaid Program

  • 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

NATIONAL (CONT)

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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

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State-specific

  • 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

MANAGED CARE PARTICIPATION

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State-specific

  • 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

MCO PROGRAM DESCRIPTIONS

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Managed Care Participation

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Example of need for enrollment by plan type:

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Managed Care Participation

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Managed Care Participation

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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

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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

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Medicaid Statistics

  • 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

  • r Safari

MSIS DATA MART

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Medicaid Statistics

MSIS DATA MART

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Medicaid Data

  • 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

STATE DRUG UTILIZATION FILES

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State Drug Utilization Files

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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?

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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

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MAX Data Support Resources

  • Buccaneer, CMS data distribution contractor

˗ Max Data User Guide ˗ Getting Started with MAX Data Files ˗ Options in Determining Dual Eligibles

ANALYTIC GUIDANCE REPORTS

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MAX Data Support Resources

  • 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

MSIS DOCUMENTATION

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MAX data Support Resources

  • 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

MEDICAID ISSUE BRIEFS

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MAX Data Support Resources

  • 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

ENVIROMENTAL SCANNING AND PROGRAM CHARACTERISTICS

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MAX Data Support Resources

  • 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

  • f claims by provider, counts of beneficiaries by

provider ˗ Documentation includes data dictionaries, validation tables and anomalies

MAX PROVIDER CHARACTERISTICS FILE

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MAX Data

  • 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 31st 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

BEYOND TRADITIONAL CLAIMS/ENROLLMENT

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MAX Data

  • 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

BEYOND TRADITIONAL CLAIMS/ENROLLMENT (CONT)

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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

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