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 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