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Medicaid Analytic eXtract (MAX)

Medicaid Analytic eXtract (MAX). Presentation to the Academy Health Annual Research Meeting San Diego, California Dave Baugh, CMS/ORDI June 8, 2004. What is MAX?. Person-based Medicaid data used for Research/evaluation Epidemiology/quality Statistics/forecasting

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Medicaid Analytic eXtract (MAX)

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  1. Medicaid Analytic eXtract (MAX) Presentation to the Academy Health Annual Research Meeting San Diego, California Dave Baugh, CMS/ORDI June 8, 2004

  2. What is MAX? • Person-based Medicaid data used for • Research/evaluation • Epidemiology/quality • Statistics/forecasting • Calendar Year (begins 1999, SMRF - prior years) • Event Based • Occurrence of eligibility • Dates of service • Final action events (hospital stays, visits, etc.) • Derived from MSIS (7 calendar quarters)

  3. Why Do We Need MAX? • Eligibility • Retroactive eligibility in proper chronology • Eligibility codes – verified and improved • Eligibility data added to each claim • Services (Claims) • Final action events (interim claims combined) • Organized by dates of service • Type of service – verified and regrouped • Person Summary File • Calendar year eligibility and summary of claims • Not available from MSIS

  4. MAX Data Sets • Person Summary File • Eligibility (annual and monthly) • Managed care enrollment • Utilization and Medicaid payment by type of service • Service Files • Inpatient hospital • Long term care • Prescription drug • Other Services • Service file records include • Fee-for-service • Prepaid plans - premium payments and encounters (incomplete)

  5. Medicaid Data EnhancementsBeginning 1999 • More detail Medicaid eligibility • Dual (Medicare and Medicaid) status • Medicaid case number • Enrollment in prepaid plans • Other eligibility (e.g. TANF, SCHIP) • Services • More diagnoses and procedures • More data (waiver enrollment, hospital cost centers) • Additional types of service (e.g. DME/supplies, adult day care) • Maternal delivery indicator

  6. MAX Data Linkages • To Medicare Enrollment Data Base (EDB) • Best way to identify dual eligibles • Begin and end dates of Medicare eligibility • Other Medicare data (e.g. Medicare HIC, date of death) • To Medi-Span and First Data Bank • Prescription drugs • Link on National Drug Code (NDC) • Therapeutic classes (clinical use) • Other FDB data (e.g. generic, OTC or prescribed drug) • Other linkages (Agreement with SSA)

  7. MAX/SMRF DataAvailability • Who has access? • Privacy Act and HIPAA regulations apply • Research protocols must be reviewed • A Data Use Agreement (DUA) must be filed • A CMS processing fee may apply • Access to Medi-Span and First Data Bank data restricted • What data are available? • Years prior to CY 1999 (SMRF) • 1992-1998 – 25-29 states full data • 1987-1991 – 5 states, data quality? • Years after CY 1998 (MAX) – all States • CY 1999 available now • CY 2000 available beginning mid-2004

  8. MAX/SMRF DataDocumentation • Documentation on the Web via: www.cms.gov/researchers/max • Data Dictionaries • Better descriptions of data elements • Improved source information • Addition of user notes • Data Validation Reports • Data Anomaly Reports • Valid data, but unexpected results (e.g. broken time series, new covered service) • Data inconsistencies (can’t be fixed)

  9. Medicaid Data LimitationsMSIS and MAX • Data not reported • Some desired beneficiary characteristics • Some aggregate payments • Provider characteristics • Incomplete data • Periods of ineligibility • Third-party insurance coverage and payments • Services for persons in prepaid plans • Service detail for dual eligibles • Drug payments are prior to rebates • Program and operational variation

  10. Estimates of Dual andFull Medicaid Benefit Dual Eligibles(Using MAX)

  11. Linkage to Medicare (EDB)Two Steps • Not available – Name and Address • Not used (initially) • Medicare Health Insurance Claim (HIC) • Medicaid dual status • Step 1 - Linking criteria • For Aged - SSN and gender • For Disabled, either • SSN and date of birth (DOB), or • SSN, gender and two of three elements in DOB • Step 2 – Linking criteria for step 1 non-links • Medicaid SSN to EDB claim account number (CAN), plus • Gender and DOB

  12. Setting Dual EligibilityAfter the link • For each linked eligibility record: Monthly Medicaid eligibility is compared to “spells” of Medicare eligibility • An dual indicator is set when dates overlap • This indicator “confirms” dual status • By month • For the year (ever a dual in the year)

  13. Estimating Dual EligiblesAdjusting for bias • Estimates adjust for • Undercounting • Medicaid-reported duals not linked • With no SSN • With incorrect/non-matching SSNs • Estimates do not adjust for • Undercounting • Medicare-reported duals not linked • Overcounting • Medicaid persons eligible in more than one state • More than one Medicaid eligible per SSN

  14. Estimating Dual EligiblesAlternative Estimates • “Best Estimate” of Duals • Confirmed duals (linked to EDB), plus • Medicaid eligibles not linked to EDB, but • Identified as dual eligibles by Medicaid, and • Had at least one claim in the year where Medicare copayment and/or deductible was paid by Medicaid • “Upper Bound Estimate” of Duals • Same as above except for • Medicaid eligibles not linked to EDB replace “and” with “and/or”, plus • Estimate not > total aged and disabled eligibles

  15. Full Medicaid Benefit Dual EligiblesBackground on Estimates • State reporting of dual status in MSIS • Incomplete at best starting in 1999 • For Calendar Year 1999 • 11 states reported > 50% unknown type • 21 states reported > 20% unknown type • 5 states reported no full duals • One state did not report type of dual

  16. Full Medicaid Benefit Dual EligiblesMethodology • “Lower Limit” estimate • By state, allocated unknown type proportionally • For the six states identified above - • Produced a combined percent of full benefit to total dual eligibles for all other states. • Multiplied this percent by the total number of dual eligibles in the state. • “Best” estimate • Same as above, except • Allocated all unknown type to full benefit

  17. Dual and Full Medicaid Benefit DualEstimates(ever in 1999) • National estimates (50 states and D.C.) • Dual eligibles • Confirmed (from EDB) – 6.823 million • Best estimate – 6.881 million • Upper bound estimate – 7.288 million • Full Medicaid Benefit Dual eligibles • Lower bound estimate – 5.916 million • Best estimate – 6.091 million • “Restricted Benefits” estimate – 6.015 million

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