Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program Appendices


TABLE OF CONTENTS

APPENDICES
APPENDIX A: Sample Selection Procedures
APPENDIX B: Recipient and Other Predictor Variables, Detailed Tables
APPENDIX C: Testing Factors Associated with Provider Selection
APPENDIX D: Hierarchical Condition Classification and Distribution for IHSS Recipients by Age and Provider Relationship
APPENDIX E: Physician, Outpatient Department, and Emergency Room Use and Expenditures
APPENDIX F: Home Care and Nursing Home Expenditures and Use
NOTES
LIST OF TABLES
TABLE B-1: Race/Ethnicity of IHSS Recipients, 2005
TABLE B-2: Functional Limitations of IHSS Recipients, 2005
TABLE B-3: Vendor Claims Counts Fee for Service and Managed Care Recipients, 2005
TABLE B-4: County Per Capita Income, 2005

TABLE C-1: Predicting Provider Relationships, IHSS Recipients Age 3-17, 2005
TABLE C-2: Predicting Provider Relationships, IHSS Recipients Age 18-64, 2005
TABLE C-3: Predicting Provider Relationships, IHSS Recipients Age 65+, 2005

TABLE D-1: Hierarchical Condition Classification Distribution for IHSS Recipients Age 3-17 by Provider Relationship, 2005
TABLE D-2: Hierarchical Condition Classification Distribution for IHSS Recipients Age 18-64 by Provider Relationship, 2005
TABLE D-3: Hierarchical Condition Classification Distribution for IHSS Recipients Age 65+ by Provider Relationship, 2005
TABLE D-4: Ambulatory Care Sensitive Conditions by Provider Relationship, Recipients Age 3-17, 2005
TABLE D-5: Ambulatory Care Sensitive Conditions by Provider Relationship, Recipients Age 18+, 2005

TABLE E-1: Adjusted Medicaid-Paid Medical Care Use, Excluding Emergency Room Use, by IHSS Recipients, 2005
TABLE E-2: Mean Medicaid-Paid Physician Expenditures by IHSS Recipients, 2005
TABLE E-3: Mean Medicaid-Paid Outpatient Department Expenditures by IHSS Recipients, 2005

TABLE F-1: Unadjusted Probability of Medicaid-Paid Nursing Home Stays by IHSS Recipients, 2005
TABLE F-2: Adjusted Medicaid-Paid Nursing Home Use by Adult IHSS Recipients, 2005
TABLE F-3: Adjusted Mean Medicaid-Paid Monthly HCBS Waiver Expenditures by IHSS Recipients, 2005
TABLE F-4: Logarithm Transformed Mean Monthly Medicaid-Paid IHSS Expenditures by IHSS Recipients, 2005
TABLE F-5: Logarithm Transformed Mean Monthly Medicaid-Paid Nursing Home Expenditures by IHSS Recipients, 2005
Main Report: http://aspe.hhs.gov/daltcp/reports/2008/IHSSPlus.htm

Appendices: http://aspe.hhs.gov/daltcp/reports/2008/IHSSPlus2.htm


APPENDIX A. SAMPLE SELECTION PROCEDURES

The study sample was selected from In-Home Supportive Services (IHSS) recipient listings in 2005. It included anyone in the program as of January 1 of that year, or who entered the IHSS program sometime during 2005. This full sample of recipients is used in analyses describing program recipient characteristics and in analysis of the factors associated with provider selection. Analysis that consider health care use, Medicaid expenditures, or that include health conditions were limited to a subset of IHSS recipients: persons receiving Medicaid through fee for service reimbursement. The exclusion of Medicaid managed care program recipients was necessary because Medicaid claims are not submitted for managed care covered services. The following outlines the steps used to select, screen, and qualify IHSS recipients into the study sample. In combination these assure that we obtained all waiver recipients in each of the target age categories as well as recipients in Advance Pay, and Restaurant Meals vouchers:

  1. All recipients identified as being an active IHSS recipient during any month in calendar year 2005 were tentatively selected into the study (n=408,276).1 Data for both 2004 and 2005 was compiled for these individuals.

  2. The tentatively eligible IHSS recipients included 4,350 pairs of recipients with the same Social Security number, but different IHSS identification numbers. This can occur as recipients are given a new IHSS number if they move from one county to another, even while being an IHSS recipient. There is also the possibility of typographical errors in the identification numbers recorded in the data files. To determine if cases with the same Social Security number were the same individuals, we compared the records on date of birth and whether they had no more than one overlapping month of claims data. Cases meeting these criteria were retained, consolidating the pair under a single common IHSS number. Of the pairs with consistent birthdates, 3,486 had no overlapping claims months, 346 had one overlapping claim month, 301 had more than one overlapping claims month. The remaining 217 pairs had different birth dates. These latter 518 cases were dropped from the study sample.

  3. An additional 42 IHSS recipients had duplicate Department of Developmental Services (DDS) identification numbers that could not be resolved. These cases were also dropped from the IHSS sample.

  4. Within the age group 3-17 any recipient with a Spouse provider (one person in 2005) was excluded because there were too few cases for subgroup analysis. Among those 65 or older, those with “Parent” providers (n=2) were similarly excluded.

  5. The final eligible IHSS sample was sorted into three subgroups: those age 3-17, those age 18-64, those age 65 or more. Individuals changing age group during the calendar year were retained in the original age group.

  6. Advance Pay and Restaurant Meals voucher program recipients were identified using the IHSS Services Assessment. This indicates recipients requesting who are eligible for the program. Such recipients were selected, and the number of participation months was compiled.

  7. IHSS recipients are eligible for Medicaid, but the number of Medicaid claims-records can be under reported for individuals enrolled in a managed care plan. Being in managed care affects the availability and reliability of Medicaid claims data. Managed care organizations are reimbursed on a capitated basis for members, rather than on the basis of utilization. As a consequence services such as hospital, physician, and outpatient services (services included under the capitation payment) may not generate a Medicaid claim. Services (e.g., community-based care, IHSS, and extended nursing home stays) not included under the capitation are not affected. In 2005, 56,1522 (13.9%) study recipients were managed care members for all or part of the year, another. All such cases were list-wise excluded from analyses using Medicaid claims for diagnoses and health care use/expenditures.

  8. IHSS recipients participating in DDS programs were identified by linking the IHSS study sample records with DDS assessment files. This match was limited to persons having Medicaid eligibility.

  9. Classification of waiver and non-waiver recipients was based on the provider relationship information available in the IHSS provider eligibility files. Among those age less that 18, waiver/Residual Program participants are those with a Parent provider. For those 18-64 and 65 or more waiver/Residual Program participants are those with a paid Spouse provider. (Parents of those age 65 or more would also be eligible, but these cases were excluded from the analysis.)2


APPENDIX B. RECIPIENT AND OTHER PREDICTOR VARIABLES, DETAILED TABLES

TABLE B-1: Race/Ethnicity of IHSS Recipients, 2005
  Age of IHSS Recipients
3-17 18-64 65+ Total
n % n % n % n %
All Recipients 2005   16,257     100.0     152,591     100.0     233,856     100.0     402,704     100.0  
White 4,580 28.2 65,400 42.9 90,562 38.7 160,542 39.9
Hispanic 7,220 44.4 32,887 21.6 55,327 23.7 95,434 23.7
Black 2,875 17.7 39,260 25.7 25,156 10.8 67,291 16.7
Other Asian or Pacific Islander   182 1.1 1,691 1.1 3,180 1.4 5,053 1.3
Am Indian or Alaskan Native 91 0.6 1,337 0.9 870 0.4 2,298 0.6
Filipino 245 1.5 1,803 1.2 12,734 5.4 14,782 3.7
Chinese 241 1.5 1,995 1.3 23,331 10.0 25,567 6.3
Cambodian 142 0.9 1,456 1.0 2,459 1.1 4,057 1.0
Japanese 12 0.1 141 0.1 329 0.1 482 0.1
Korean 62 0.4 590 0.4 4,334 1.9 4,986 1.2
Samoan 25 0.2 291 0.2 319 0.1 635 0.2
Asian Indian 84 0.5 471 0.3 1,766 0.8 2,321 0.6
Hawaiian 13 0.1 44 0.0 42 0.0 99 0.0
Guamanian 5 0.0 53 0.0 44 0.0 102 0.0
Laotian 132 0.8 2,120 1.4 3,146 1.3 5,398 1.3
Vietnamese 348 2.1 3,052 2.0 10,257 4.4 13,657 3.4
Recipients Continuing from 2004   13505   126118   198523   338146  
White 3783 28.0 54032 42.8 78927 39.8 136742 40.4
Hispanic 6087 45.1 27241 21.6 45888 23.1 79216 23.4
Black 2366 17.5 32342 25.6 21961 11.1 56669 16.8
Other Asian or Pacific Islander 143 1.1 1372 1.1 2578 1.3 4093 1.2
Am Indian or Alaskan Native 74 0.5 1075 0.8 721 0.4 1870 0.6
Filipino 196 1.4 1450 1.1 10002 5.0 11648 3.4
Chinese 180 1.3 1652 0.3 19380 9.8 21212 6.3
Cambodian 130 1.0 1219 1.0 2190 1.1 3539 1.0
Japanese 11 0.1 118 0.1 250 0.1 379 0.1
Korean 47 0.03 470 0.4 3474 1.7 3991 1.2
Samoan 20 0.01 218 0.2 258 0.1 496 0.1
Asian Indian 65 0.05 368 0.3 1431 0.7 1864 0.6
Hawaiian 10 0.1 38 0.03 31 0.02 79 0.02
Guamanian 4 0.03 41 0.03 38 0.02 83 0.02
Laotian 112 0.8 1831 0.5 2820 1.4 4763 1.4
Vietnamese 277 2.1 2651 2.1 8574 4.3 11502 3.4
Recipients Entering in 2005 2752   26473   35333   64558  
White 797 29.0 11368 42.9 11635 32.9 23800 36.9
Hispanic 1133 41.2 5646 21.3 9439 26.7 16218 25.1
Black 509 18.5 6918 26.1 3195 9.0 10622 16.5
Other Asian or Pacific Islander 39 1.4 319 1.2 602 1.7 960 1.5
Am Indian or Alaskan Native 17 0.6 262 1.0 149 0.4 428 1.7
Filipino 49 1.8 353 1.3 2732 7.7 3134 4.9
Chinese 61 2.2 343 1.3 3951 11.2 4355 6.7
Cambodian 12 0.4 237 0.9 269 0.8 518 0.8
Japanese 1 0.04 23 0.09 79 0.2 103 0.2
Korean 15 0.5 120 0.5 860 2.4 995 1.5
Samoan 5 0.2 73 0.3 61 0.2 139 0.2
Asian Indian 19 0.7 103 0.4 335 0.9 457 0.7
Hawaiian 3 0.1 6 0.02 11 0.03 20 0.03
Guamanian 1 0.04 12 0.04 6 0.02 19 0.03
Laotian 20 0.7 289 1.1 326 0.9 635 1.0
Vietnamese 71 2.6 401 1.5 1683 4.8 2155 3.3


TABLE B-2: Functional Limitations of IHSS Recipients, 2005
  Age of IHSS Recipients
3-17 18-64 65+ Total
n % n % n % n %
Functional Areas     16,257     100.0     152,591     100.0     233,856     100.0     402,704     100.0  
Cognitive Limitationsa
  0 12,346 75.9 141,114 92.5 227,051 97.1 380,511 94.5
  1 914 5.6 2,580 1.7 1,682 0.7 5,176 1.3
  2 501 3.1 1,685 1.1 1,022 0.4 3,208 0.8
  3 2,496 15.4 7,212 4.7 4,101 1.8 13,809 3.4
ADL Limitationsb
  0 545 3.4 23,539 15.4 26,619 11.4 50,703 12.6
  1 805 5.0 21,862 14.3 35,331 15.1 57,998 14.4
  2 1,732 10.7 29,866 19.6 44,513 19.0 76,111 18.9
  3 3,962 24.4 27,676 18.1 41,947 17.9 73,585 18.3
  4 4,567 28.1 31,760 20.8 57,932 24.8 94,259 23.4
  5 4,646 28.6 17,888 11.7 27,514 11.8 50,048 12.4
IADL Limitationsc
  0 2,571 15.8 215 0.1 83 0.0 2,869 0.7
  1 1,826 11.2 581 0.4 508 0.2 2,915 0.7
  2 678 4.2 1,338 0.9 1,209 0.5 3,225 0.8
  3 730 4.5 5,072 3.3 5,676 2.4 11,478 2.9
  4 6,716 41.3 89,577 58.7 115,673 49.5 211,966 52.6
  5 3,736 23.0 55,808 36.6 110,707 47.3 170,251 42.3
Breathingd 2,352 14.5 10,623 7.0 14,219 6.1 27,194 6.8
  1. Number of tasks cannot perform memory, orientation, or judgment tasks without human assistance.
  2. Number of tasks cannot perform assistance in activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual care; eating) without human assistance.
  3. Number of tasks cannot perform instrumental activities of daily living (i.e., housework, laundry, shopping and errands, meal preparation and clean-up, mobility inside) without human assistance.
  4. Cannot breathe without human assistance.


TABLE B-3: Vendor Claims Counts Fee for Service and Managed Care Recipients, 2005
Vendor Group Descriptions Total
  # Recipients   % # MC %
Community-Based Care
Adult Day Health Care 31,418 7.9% 2,018 3.8%
IHSS (State Plan Personal Care) 366,625   92.5%     48,982     91.3%  
Medicaid Home Care Waiversa 13,638 3.4% 2,100 3.9%
Home Health Agency 7,088 1.8% 398 0.7%
Inpatient Services
Hospital (County & Community hospitals)   100,127 25.3% 4,496 8.4%
Nursing Homes (and ICF-DDs) 18,585 4.7% 776 1.4%
Medical Care/Physician Services
Birthing Servicesb 183 0.0% 49 0.1%
Physician Offices/Clinicsc 300,203 75.8% 17,182 32.0%
Outpatient Departments/Clinicsd 193,697 48.9% 6,946 12.9%
Mental Health Servicese 951 0.2% 62 0.1%
Other Providers
Ancillary Providersf 65,436 16.5% 1,847 3.4%
Physical/Occupational/Speech Therapyg   10,627 2.7% 1,463 2.7%
Vision/Hearing Servicesh 114,187 28.8% 10,201 19.0%
Other Servicesi 79,108 20.0% 5,081 9.5%
Durable Medical Equipment 112,749 28.5% 4,151 7.7%
Medical Transportation 56,244 14.2% 1,685 3.1%
Total 394,987   53,571  
  1. Includes AIDS waiver, MSSP, and Home Care waivers.
  2. Includes nurse midwife (n=32 FFS and 2 MC clients), and genetic testing (n=153 FFS and 47 MC clients).
  3. Includes nurse practitioners, physicians, physician groups, rural clinics, surgi-centers.
  4. Includes county and community hospital outpatient departments, and other organized outpatient clinics.
  5. Includes psychologist/social worker outpatient services, and inpatient mental health.
  6. Includes acupuncturist, chiropractor, podiatrist, prosthetist, breast cancer detection center, EPSDT supplemental services, hemodialysis/renal centers, respirator care practitioner, hospice services, nurse anesthetist.
  7. Also includes hospital and freestanding rehabilitation facilities.
  8. Includes optical labs, optometric groups, optometrists, optician, audiologist, hearing aid dispenser.
  9. Includes clinical labs, portable x-ray lab, blood bank, local health education.


TABLE B-4: County Per Capita Income, 2003
County Per Capita
  Income/1000  
Population		   IHSS Recipients  
by County		 County Per Capita
  Income/1000  
Population		   IHSS Recipients  
by County
ALAMEDA 38.618 14,508 ORANGE 36.647 13,702
ALPINE 24.946 15 PLACER 35.847 1,498
AMADOR 23.570 214 PLUMAS 26.597 371
BUTTE 22.818 3,389 RIVERSIDE 25.691 14,629
CALAVERAS 23.537 313 SACRAMENTO 29.548 18,342
COLUSA 21.668 226 SAN BENITO 23.484 352
CONTRA COSTA   41.992 7,208 SAN BERNARDINO   22.141 18,801
DEL NORTE 17.676 367 SAN DIEGO 33.883 22,977
EL DORADO 33.477 679 SAN FRANCISCO 55.819 18,468
FRESNO 21.938 12,640 SAN JOAQUIN 23.155 6,784
GLENN 18.031 453 SAN LUIS OBISPO 27.917 1,695
HUMBOLDT 23.909 2,116 SAN MATEO 57.906 2,667
IMPERIAL 18.171 5,117 SANTA BARBARA 33.739 2.824
INYO 26.084 137 SANTA CLARA 51.579 12,395
KERN 21.021 5,647 SANTA CRUZ 36.865 2,005
KINGS 16.717 1,619 SHASTA 25.175 2,932
LAKE 23.538 1,974 SIERRA 24.681 34
LASSEN 18.122 287 SISKIYOU 22.640 553
LOS ANGELES 30.611 167,927 SOLANO 26.830 2,886
MADERA 18.392 1,615 SONOMA 34.671 4,319
MARIN 63.083 1,484 STANISLAUS 22.677 5,701
MARIPOSA 22.903 270 SUTTER 24.075 712
MENDOCINO 25.947 1,549 TEHAMA 19.868 1,263
MERCED 18.461 3,112 TRINITY 21.223 192
MODOC 21.275 163 TULARE 20.166 2,787
MONO 24.241 44 TUOLUMNE 23.515 341
MONTEREY 29.901 3,199 VENTURA 32.232 3,408
NAPA 37.086 690 YOLO 27.332 1,506
NEVADA 31.241 799 YUBA 19.236 829
SOURCE: Table D-9, US Department of Commerce, Bureau of Economic Analysis, http://www.bea.doc.gov


APPENDIX C. TESTING FACTORS ASSOCIATED WITH PROVIDER SELECTION

The analyses presented in this Appendix extend the descriptive findings using logistic regression to adjust for recipient differences within a provider group. Separate analyses are conducted by recipient age group to address the following questions:

The “outcome” of these models is provider type. The recipient data are from the first available IHSS assessment instrument available prior to the start of the observation period. Most of the models, Table C-1, Table C-2 and Table C-3, include all IHSS recipients in the modeled age group, but there are three exceptions. The models predicting Parent providers among those age 3-17 are limited to minor children with a parent in the household. Similarly, the models predicting Spouse providers among adults are limited to persons with a spouse in the household. The Authorized IHSS Service Hours, while it may reflect unmeasured functional status is not included in these models as this measure is determined in part by living arrangement and provider type.

The coefficient of primary interest in these models is the dummy variable representing recipients entering IHSS in 2005 versus those who were continuing from 2004. Among minor children, those with Parent providers are less likely to be newly entering IHSS recipients in 2005, and those with Non-Relative providers are more likely to be new recipients. Non-aged adults reflect a somewhat similar pattern with those having Parent or Spouse providers being less likely to be new recipients. Correspondingly, new recipients had higher odds of having either Other Relatives and Non-Relative providers. This pattern changes somewhat among those 65+. New IHSS recipients have higher odds than continuing recipients of having a Spouse provider, and slightly lower odds of having a Non-Relative provider. There is no difference between recipient participation status in the odds of having Other Relative providers. These findings suggest that between 2004 and 2005 (the starting year for the IHSS Plus Waiver program) there was no consistent pattern in the enrollment of new recipients shifting them toward waiver covered providers (i.e., parents for minor children recipients, spouses for adult recipients). Among children the opposite occurred, with new recipients being less likely than continuing recipients to be among those with Parent providers. Among non-aged adults there was no difference in the odds of new recipients using Spouse providers. Only among those age 65+ did new recipients have greater odds than continuing recipients of having a Spouse provider.

Turning now to the other policy questions, the coefficients in the models provide indicators of the statistically significant differences within provider type relative to race/ethnicity, functional ability, and living arrangement.

The findings from the tables are briefly summarized here:

TABLE C-1: Predicting Provider Relationships, IHSS Recipients Age 3-17, 2005
Total Recipients
n=16257		 Provider Relationship
Parentg
n=11056		 Other Relative
n=2090		 Non-Relative
n=2589
Predictors   Odds Ratio   95% CI   Odds Ratio   95% CI   Odds Ratio   95% CI
Intercept            
Recipient Characteristicsa
Female Recipient 1.04   0.96-1.12   0.95   0.86-1.05   0.99   0.91-1.08  
Hispanic 1.94 1.75-2.14 0.79 0.70-0.90 0.44 0.40-0.50
Black 0.80 0.71-0.90 1.63 1.42-1.88 0.87 0.77-0.98
Asian/Other 1.28 1.10-1.48 1.21 1.01-1.43 0.57 0.49-0.67
3+ Cognitive Limitationsb 1.22 1.11-1.35 0.83 0.73-0.93 0.86 0.77-0.95
3+ ADL Limitationsc 1.17 1.06-1.30 0.88 0.78-0.99 0.85 0.77-0.95
Respiratory Limitationsd 1.15 1.03-1.29 0.99 0.86-1.14 0.80 0.70-0.91
Managed Care Member 1.08 0.98-1.18 0.93 0.83-1.04 0.90 0.81-0.99
Living Arrangement
Parent Present (n=14623)   na na 0.19 0.17-0.21 0.47 0.42-0.53
Household size (1-5)e 0.98 0.94-1.02 1.10 1.05-1.15 0.93 0.89-0.97
County Measures
IHSS Wage Ratef            
  <$7.50 per hour 1.08 0.96-1.23 0.74 0.63-0.87 1.02 0.89-1.16
  $8 per hour 1.30 1.17-1.45 0.92 0.81-1.05 0.69 0.61-0.79
  $9.50-$9.75 per hour 0.88 0.78-1.01 1.00 0.85-1.18 1.07 0.92-1.23
  >$10 per hour 0.64 0.49-0.83 1.11 0.81-1.52 0.93 0.71-1.23
Per Capita Income (000’s) 0.97 0.97-0.98 1.01 1.00-1.02 1.03 1.02-1.04
New IHSS Recipient 0.69 0.63-0.76 1.03 0.91-1.07 1.43 1.28-1.59
Model Goodness of Fit
-2Log Likelihood   15536.5       11471.0       13493.0    
Maximum Rescaled R2 0.071   0.112   0.078  
SOURCE: California Department of Social Services, unpublished CMIPS data for 2005.
  1. Reference is White. Race/ethnicity Asian/Other includes in descending order by number in this age group, Vietnamese, Filipino, Chinese, Cambodian, Laotian, American Indian or Alaskan Native, Asian Indian, Korean, Samoan, Hawaiian, Japanese, and all others.
  2. Cognition is defined by: memory, orientation, and judgment. Each scored 1 independent; 2 able to perform, but needs verbal assistance such as reminders, guidance, or encouragement; 5 cannot perform without human assistance. Scores three and four not used. The measure is a dummy variable yes = have three cognitive measures each with a score five.
  3. ADLs refers to activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual; eating). Each task is scored on a four or five point scale: 1 and 2 as per above, 3 Can perform with some human direct physical assistance from the provider, 4 Can perform with a lot of human assistance, 5 cannot perform without human assistance. The measure is a dummy variable yes = have three or more ADLs each with a score of three or more indicating the need for human assistance.
  4. Breathing is scored 1 independent, 5 cannot perform without human assistance, 6 paramedical services needed. The measure is the presence/absence of a breathing item with a score of five or more.
  5. Number of persons in household, including other IHSS recipients, excludes recipients non-IHSS children <age 14.
  6. The omitted category for IHSS wages is $7.50/hr (reflective of Los Angeles and Fresno Counties residence for about 44% of IHSS recipients.
  7. The model includes only recipients who have a parent present, n shown in the column heading is the number of Parent providers, n shown in the Parent Present row is the number of parents available in the sample. “na” is not applicable.


TABLE C-2: Predicting Provider Relationships, IHSS Recipients Age 18-64, 2005
Total Recipients
n=152,591		 Provider Relationship
Parent
n=23,492		 Spouseg
n=8,132 		Other Relative
n=49,407		 Non-Relative
n=70,974
Predictors   Odds Ratio   95% CI   Odds Ratio   95% CI   Odds Ratio   95% CI   Odds Ratio   95% CI
Intercept                
Recipient Characteristicsa
Female Recipient 0.50   0.48-0.51   0.31   0.29-0.33   2.04   1.99-2.09   0.90   0.88-0.92  
Hispanic 1.42 1.37-1.48 2.51 2.33-2.71 1.16 1.12-1.19 0.56 0.55-0.58
Black 0.56 0.53-0.58 1.54 1.38-1.72 1.32 1.28-1.36 0.90 0.88-0.93
Asian/Other 0.86 0.81-0.91 1.57 1.44-1.72 1.79 1.72-1.86 0.51 0.49-0.53
3+ Cognitive Limitationsb 4.10 3.92-4.28 2.21 1.84-2.67 0.54 0.51-0.57 0.45 0.43-0.48
3+ ADL Limitationsc   1.53 1.48-1.58 5.27 4.90-5.68 0.75 0.74-0.77 0.85 0.83-0.87
Respiratory Limitationsd 0.97 0.91-1.03 1.29 1.16-1.44 0.91 0.87-0.95 1.05 1.01-1.10
Managed Care Member 1.22 1.17-1.27 1.41 1.31-1.53 0.89 0.87-0.92 0.94 0.91-0.97
Living Arrangement
Spouse Present (n=25,516) 0.03 0.02-0.03 na na 1.55 1.51-1.60 0.40 0.39-0.41
Household size (1-5)e 1.53 1.51-1.54 0.99 0.97-1.02 1.24 1.23-1.25 0.65 0.64-0.65
County Measures
IHSS Wage Ratef                
  <$7.50 per hour 1.10 1.04-1.15 2.07 1.90-2.26 0.61 0.59-0.63 1.27 1.23-1.31
  $8 per hour 1.39 1.33-1.45 2.06 1.89-2.26 0.80 0.77-0.82 0.89 0.86-0.92
  $9.50-$9.75 per hour 0.93 0.88-0.98 1.29 1.17-1.43 0.94 0.91-0.97 1.04 1.00-1.07
  >$10 per hour 0.78 0.70-0.87 1.59 1.28-1.98 0.90 0.83-0.97 1.19 1.10-1.28
Per Capita Income (000’s) 1.01 1.01-1.01 1.00 0.99-1.01 0.98 0.98-0.98 1.01 1.01-1.02
New IHSS Recipient 0.57 0.55-0.60 0.95 0.88-1.03 1.14 1.11-1.18 1.11 1.08-1.14
Model Goodness of Fit
-2Log Likelihood   103,330.5       25,616.7       181,058.3       185,067.1    
Maximum Rescaled R2 0.288   0.307   0.098   0.207  
SOURCE: California Department of Social Services, unpublished CMIPS data for 2005.
  1. Reference is White. Race/ethnicity Asian/Other includes in descending order by number in this age group, Vietnamese, Laotian, Chinese, Filipino, Cambodian, American Indian or Alaskan Native, Korean, Asian Indian, Samoan, Japanese, and others.
  2. Cognition is defined by: memory, orientation, and judgment. Each scored 1 independent; 2 able to perform, but needs verbal assistance such as reminders, guidance, or encouragement; 5 cannot perform without human assistance. Scores three and four not used. The measure is a dummy variable yes = have three cognitive measures each with a score five.
  3. ADLs refers to activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual; eating). Each task is scored on a four or five point scale: 1 and 2 as per above, 3 Can perform with some human direct physical assistance from the provider, 4 Can perform with a lot of human assistance, 5 cannot perform without human assistance. The measure is a dummy variable yes = have three or more ADLs each with a score of three or more indicating the need for human assistance.
  4. Breathing is scored 1 independent, 5 cannot perform without human assistance, 6 paramedical services needed. The measure is the presence/absence of a breathing item with a score of five or more.
  5. Number of persons in household, including other IHSS recipients, excludes recipients non-IHSS children <age 14.
  6. The omitted category for IHSS wages is $7.50/hr (reflective of Los Angeles and Fresno Counties residence for about 44% of IHSS recipients.
  7. The model includes only recipients who have a spouse present, n shown in the column heading is the number of Spouse providers, n shown in the Spouse Present row is the number of spouses available in the IHSS recipient sample. “na” is not applicable.


TABLE C-3: Predicting Provider Relationships, IHSS Recipients 65+ or More, 2005
Total Recipients
n=233,856		 Provider Relationship
Spouseg
n=5,130 		Other Relative
n=123,496 		Non-Relative
n=104,971
Predictors   Odds Ratio   95% CI   Odds Ratio   95% CI   Odds Ratio   95% CI
Intercept            
Recipient Characteristics
Female Recipient 0.23   0.21-0.24   1.38   1.35-1.41   0.85   0.84-0.87  
Hispanica 4.75 4.37-5.17 1.13 1.10-1.16 0.76 0.75-0.78
Blacka 3.64 3.10-4.27 0.94 0.92-0.97 0.98 0.95-1.01
Asian/Othera 2.31 2.12-2.52 1.46 1.42-1.49 0.63 0.62-0.65
3+ Cognitive Limitationsb 1.58 1.34-1.86 0.98 0.93-1.03 0.98 0.93-1.03
3+ ADL Limitationsc 7.79 7.12-8.51 1.03 1.01-1.05 0.84 0.82-0.85
Respiratory Limitationsd 1.48 1.34-1.64 0.93 0.90-0.96 1.02 0.98-1.05
Managed Care Member 1.16 1.05-1.29 1.08 1.05-1.11 0.90 0.87-0.93
Living Arrangement
Spouse Present (n=69,034)   na na 1.10 1.08-1.12 0.68 0.66-0.69
Household size (1-5+)e 0.88 0.86-0.91 1.60 1.59-1.61 0.63 0.62-0.63
County Measures
IHSS Wage Ratef            
  <$7.50 per hour 1.99 1.80-2.20 0.79 0.77-0.81 1.16 1.12-1.19
  $8 per hour 1.86 1.70-2.04 1.23 1.19-1.26 0.75 0.73-0.77
  $9.50-$9.75 per hour 1.32 1.19-1.48 1.17 1.13-1.20 0.82 0.79-0.84
  >$10 per hour 0.88 0.72-1.09 1.06 1.00-1.12 0.94 0.89-1.00
Per Capita Income (000’s) 1.00 1.00-1.01 0.99 0.98-0.99 1.02 1.01-1.02
New IHSS Recipients 1.32 1.22-1.44 1.02 0.99-1.04 0.95 0.93-0.97
Model Goodness of Fit
-2Log Likelihood   29,318.4       296,098.0       289,899.0    
Maximum Rescaled R2 0.242   0.147   0.170  
SOURCE: California Department of Social Services, unpublished CMIPS data for 2005.
  1. Reference is White. Race/ethnicity Asian/Other includes in descending order by number in this age group, Chinese, Filipino, Vietnamese, Korean, Laotian, Cambodian, Asian Indian, American Indian or Alaskan Native, Japanese, Samoan, and all others.
  2. Cognition is defined by: memory, orientation, and judgment. Each scored 1 independent; 2 able to perform, but needs verbal assistance such as reminders, guidance, or encouragement; 5 cannot perform without human assistance. Scores three and four not used. The measure is a dummy variable yes = have three cognitive measures each with a score five.
  3. ADLs refers to activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual; eating). Each task is scored on a four or five point scale: 1 and 2 as per above, 3 Can perform with some human direct physical assistance from the provider, 4 Can perform with a lot of human assistance, 5 cannot perform without human assistance. The measure is a dummy variable yes = have three or more ADLs each with a score of three or more indicating the need for human assistance.
  4. Breathing is scored 1 independent, 5 cannot perform without human assistance, 6 paramedical services needed. The measure is the presence/absence of a breathing item with a score of five or more.
  5. Number of persons in household, including other IHSS recipients, excludes recipient’s non-IHSS children <age 14.
  6. The omitted category for IHSS wages is $7.50/hr (reflective of Los Angeles and Fresno Counties residence for about 44% of IHSS recipients.
  7. The model includes only recipients who have a spouse present, n shown in the column heading is the number of Spouse providers, n shown in the Spouse Present row is the number of spouses available in the IHSS recipient sample. “na” is not applicable.


APPENDIX D. HIERARCHICAL CONDITION CLASSIFICATION AND DISTRIBUTION FOR IHSS RECIPIENTS BY AGE AND PROVIDER RELATIONSHIP

TABLE D-1: Hierarchical Condition Classification Distribution for IHSS Recipients Age 3-17 by Provider Relationship, 2005
HCC Parents Other Relative Non-Relative
# % # % # %
  Total Recipients   8,293     100.0     1,455     100.0     1,835     100.0  
  Recipients w/any HCC 6,740 81.3 1,055 72.5 1,261 68.7
 
  Infectious and Parasitic Disease            
1 HIV/AIDS 12 0.1 7 0.5 12 0.7
2 Septicemia/Shock 64 0.8 4 0.3 7 0.4
3 Central Nervous System Infection 31 0.4 3 0.2 6 0.3
4 Tuberculosis 13 0.2 8 0.5 0 -
5 Opportunistic Infections 12 0.1 1 0.1 2 0.1
6 Other Infectious Diseases 967 11.7 141 9.7 152 8.3
  NEOPLASMS            
7 Metastatic Cancer & Acute Leukemia 54 0.7 8 0.5 5 0.3
8 Lung, Upper Digestive Tract, & Other Severe Cancers 11 0.1 1 0.1 0 -
9 Lymphatic, Head & Neck, Brain, and Other Major Cancers 117 1.4 10 0.7 15 0.8
10 Breast, Prostate, Colorectal & Other Cancers & Tumors 114 1.4 11 0.8 14 0.8
11 Other Respiratory & Heart Neoplasms 15 0.2 1 0.1 1 0.1
12 Other Digestive & Urinary Neoplasms 24 0.3 1 0.1 5 0.3
13 Other Neoplasms 82 1.0 7 0.5 9 0.5
14 Benign Neoplasms of Skin, Breast, Eye 49 0.6 12 0.8 9 0.5
a Endocrine, Nutritional and Metabolic Disorders            
15 Diabetes with Renal or Peripheral Circulatory Manifestation 4 0.0 1 0.1 0 -
16 Diabetes with Neurologic or Other Specified Manifestation 7 0.1 1 0.1 2 0.1
17 Diabetes with Acute Complications 6 0.1 4 0.3 4 0.2
18 Diabetes with Ophthalmologic or Unspecified Manifestation 10 0.1 1 0.1 4 0.2
19 Diabetes without Complication 101 1.2 15 1.0 13 0.7
21 Protein-Calorie Malnutrition 29 0.3 4 0.3 4 0.2
22 Other Significant Endocrine and Metabolic Disorders 193 2.3 25 1.7 26 1.4
23 Disorders of Fluid/Electrolyte/Acid-Base Balance 87 1.0 14 1.0 13 0.7
24 Other Endocrine, Metabolic, or Nutritional Disorders 417 5.0 66 4.5 61 3.3
  Liver and Gallbladder Disease            
25 End-Stage Liver Disease 9 0.1 3 0.2 1 0.1
26 Cirrhosis of Liver 4 0.0 2 0.1 0 -
27 Chronic Hepatitis 7 0.1 1 0.1 0 -
28 Acute Liver Failure/Disease 3 0.0 0 - 1 0.1
29 Other Hepatitis & Liver Disease 48 0.6 6 0.4 3 0.2
30 Gallbladder & Biliary Tract Disorders 26 0.3 2 0.1 4 0.2
  Gastrointestinal Disease/Disorders            
31 Intestinal Obstruction/Perforation 97 1.2 20 1.4 9 0.5
32 Pancreatic Disease 82 1.0 4 0.3 10 0.5
33 Inflammatory Bowel Disease 12 0.1 1 0.1 4 0.2
34 Peptic Ulcer, Hemorrhage, Other Specified Gastrointestinal Disorders 125 1.5 17 1.2 12 0.7
35 Appendicitis 16 0.2 5 0.3 1 0.1
36 Other Gastrointestinal Disorders 1,492 18.0 202 13.9 203 11.1
  Musculoskeletal/Connective Tissue Disease Disorders            
37 Bone/Joint/Muscle Infections/Necrosis 34 0.4 9 0.6 2 0.1
38 Rheumatoid Arthritis & Inflammatory Connective Tissue Disease 56 0.7 5 0.3 13 0.7
39 Disorders of the Vertebrae & Spinal Discs 654 7.9 76 5.2 96 5.2
40 Osteoarthritis of Hip or Knee 10 0.1 1 0.1 3 0.2
41 Osteoporosis & Other Bone/Cartilage Disorders 157 1.9 20 1.4 12 0.7
42 Congenital/Developmental Skeletal and Connective Tissue Disorders 214 2.6 37 2.5 26 1.4
43 Other Musculoskeletal & Connective Tissue Disorders 1,384 16.7 175 12.0 214 11.7
  Blood and Blood Forming Organ Disease/Disorders            
44 Severe Hematological Disorders 66 0.8 5 0.3 8 0.4
45 Disorders of Immunity 37 0.4 8 0.5 14 0.8
46 Coagulation Defects & Other Specified Hematological Disorders 67 0.8 9 0.6 8 0.4
47 Iron Deficiency & Other Unspecified Anemias & Blood Disease 163 2.0 27 1.9 27 1.5
  Mental Disorders            
48 Delirium & Encephalopathy 147 1.8 37 2.5 15 0.8
49 Dementia/Cerebral Degeneration 319 3.8 29 2.0 43 2.3
50 Nonpsychotic Organic Brain Syndromes/Conditions 132 1.6 14 1.0 16 0.9
51 Drug/Alcohol Psychosis 1 0.0 1 0.1 0 -
52 Drug/Alcohol Dependence 3 0.0 0 - 1 0.1
53 Drug/Alcohol Abuse, Without Dependence 1 0.0 1 0.1 3 0.2
54 Schizophrenia 14 0.2 3 0.2 3 0.2
55 Major Depressive, Bipolar, and Paranoid Disorders 51 0.6 12 0.8 11 0.6
56 Reactive and Unspecified Psychosis 17 0.2 4 0.3 6 0.3
57 Personality Disorders 10 0.1 0 - 1 0.1
58 Depression 38 0.5 9 0.6 7 0.4
59 Anxiety Disorders 71 0.9 14 1.0 10 0.5
60 Other Psychiatric Disorders 214 2.6 32 2.2 40 2.2
  Mental Retardation/Developmental Disability            
61 Profound Mental Retardation, Developmental Disability 87 1.0 7 0.5 10 0.5
62 Severe Mental Retardation, Developmental Disability 41 0.5 8 0.5 9 0.5
63 Moderate Mental Retardation, Developmental Disability 20 0.2 7 0.5 5 0.3
64 Mild Mental Retardation, Autism, Down's Syndrome 860 10.4 111 7.6 136 7.4
65 Other Developmental Disability 438 5.3 69 4.7 62 3.4
66 Attention Deficit Disorder 190 2.3 37 2.5 55 3.0
  Central Nervous System Injuries/Disorders            
67 Quadriplegia/Other Extensive Paralysis 667 8.0 102 7.0 103 5.6
68 Paraplegia 162 2.0 36 2.5 29 1.6
69 Spinal Cord Disorders/Injuries 488 5.9 66 4.5 68 3.7
70 Muscular Dystrophy 134 1.6 14 1.0 22 1.2
71 Polyneuropathy 81 1.0 14 1.0 12 0.7
72 Multiple Sclerosis 6 0.1 0 - 1 0.1
73 Parkinson's & Huntington's Diseases 4 0.0 1 0.1 0 -
74 Seizure Disorders & Convulsions 1,583 19.1 243 16.7 267 14.6
75 Coma, Brain Compression/Anoxic Damage 45 0.5 6 0.4 6 0.3
76 Mononeuropathy, Other Neurological Conditions/Injuries 144 1.7 16 1.1 20 1.1
  Respiratory System Disorders            
77 Respirator Dependence, Tracheostomy Status 148 1.8 11 0.8 19 1.0
78 Respiratory Arrest 11 0.1 1 0.1 3 0.2
79 Cardio-Respiratory Failure & Shock 284 3.4 35 2.4 45 2.5
  Cardiovascular System Disease/Disorders            
80 Congestive Heart Failure 130 1.6 16 1.1 10 0.5
81 Acute Myocardial Infarction 1 0.0 0 - 1 0.1
82 Unstable Angina & Other Acute Ischemic Heart Disease 3 0.0 1 0.1 0 -
83 Angina Pectoris/Old Myocardial Infarction 4 0.0 0 - 0 -
84 Coronary Atherosclerosis/Other Chronic Ischemic Heart Disease 11 0.1 1 0.1 2 0.1
85 Heart Infection/Inflammation, Except Rheumatic 29 0.3 2 0.1 3 0.2
86 Valvular & Rheumatic Heart Disease 130 1.6 8 0.5 18 1.0
87 Major Congenital Cardiac, Circulatory Defect 97 1.2 10 0.7 8 0.4
88 Other Congenital Heart/Circulatory Disease 220 2.7 23 1.6 21 1.1
89 Hypertensive Heart & Renal Disease or Encephalopathy 12 0.1 0 - 3 0.2
90 Hypertensive Heart Disease 5 0.1 1 0.1 0 -
91 Hypertension 97 1.2 11 0.8 14 0.8
92 Specified Heart Arrhythmias 46 0.6 6 0.4 7 0.4
93 Other Heart Rhythm & Conduction Disorders 114 1.4 20 1.4 13 0.7
94 Other & Unspecified Heart Disease 84 1.0 12 0.8 5 0.3
  Cerebral and Other Vascular System Disease/Disorders            
95 Cerebral Hemorrhage 24 0.3 1 0.1 6 0.3
96 Ischemic or Unspecified Stroke 21 0.3 2 0.1 4 0.2
97 Precerebral Arterial Occlusion & Transient Cerebral Ischemia 14 0.2 0 - 5 0.3
98 Cerebral Atherosclerosis & Aneurysm 11 0.1 1 0.1 2 0.1
99 Cerebrovascular Disease, Unspecified 8 0.1 1 0.1 1 0.1
100 Hemiplegia/Hemiparesis 129 1.6 21 1.4 16 0.9
101 Cerebral Palsy & Other Paralytic Syndromes 1,122 13.5 177 12.2 170 9.3
102 Speech, Language, Cognitive, Perceptual Deficits 5 0.1 1 0.1 2 0.1
103 Cerebrovascular Disease Late Effects, Unspecified 3 0.0 0 - 1 0.1
104 Vascular Disease with Complications 17 0.2 3 0.2 1 0.1
105 Vascular Disease 32 0.4 2 0.1 4 0.2
106 Other Circulatory Disease 53 0.6 5 0.3 10 0.5
  Pulmonary System Disease/Disorders            
107 Cystic Fibrosis 48 0.6 10 0.7 10 0.5
108 Chronic Obstructive Pulmonary Disease 182 2.2 24 1.6 28 1.5
109 Fibrosis of Lung & Other Chronic Lung Disorders 91 1.1 12 0.8 22 1.2
110 Asthma 846 10.2 137 9.4 141 7.7
111 Aspiration & Specified Bacterial Pneumonias 146 1.8 20 1.4 28 1.5
112 Pneumococcal Pneumonia, Empyema, Lung Abscess 44 0.5 4 0.3 6 0.3
113 Viral & Unspecified Pneumonia, Pleurisy 633 7.6 86 5.9 96 5.2
114 Pleural Effusion/Pneumothorax 64 0.8 5 0.3 11 0.6
115 Other Lung Disorders 1,266 15.3 184 12.6 195 10.6
  Eyes and Vision Disorders            
116 Legally Blind 24 0.3 3 0.2 5 0.3
117 Major Eye Infections, Inflammations 7 0.1 0 - 5 0.3
118 Retinal Detachment 22 0.3 1 0.1 4 0.2
119 Proliferative Diabetic Retinopathy & Vitreous Hemorrhage 0 - 0 - 1 0.1
120 Diabetic & Other Vascular Retinopathies 34 0.4 5 0.3 7 0.4
121 Retinal Disorders, Except Detachment & Vascular Retinopathies 25 0.3 3 0.2 1 0.1
122 Glaucoma 54 0.7 6 0.4 4 0.2
123 Cataract 26 0.3 6 0.4 5 0.3
124 Other Eye Disorders 1,290 15.6 160 11.0 184 10.0
  Ear, Nose, and Throat Disorders            
125 Significant Ear, Nose, & Throat Disorders 46 0.6 5 0.3 7 0.4
126 Hearing Loss 218 2.6 28 1.9 24 1.3
127 Other Ear, Nose, Throat, & Mouth Disorders 3,802 45.8 556 38.2 613 33.4
  Renal System Disorders            
128 Kidney Transplant Status 23 0.3 6 0.4 5 0.3
130 Dialysis Status 11 0.1 1 0.1 3 0.2
131 Renal Failure 63 0.8 6 0.4 7 0.4
132 Nephritis 16 0.2 1 0.1 0 -
  Other Genitourinary System Disorders            
133 Urinary Obstruction & Retention 311 3.8 38 2.6 24 1.3
134 Incontinence 99 1.2 21 1.4 17 0.9
135 Urinary Tract Infection 384 4.6 49 3.4 56 3.1
136 Other Urinary Tract Disorders 170 2.0 22 1.5 17 0.9
137 Female Infertility 0 - 0 - 0 -
138 Pelvic Inflammatory Disease & Other Specified Female Genital Disorders 21 0.3 3 0.2 2 0.1
139 Other Female Genital Disorders 146 1.8 32 2.2 35 1.9
140 Male Genital Disorders 115 1.4 21 1.4 15 0.8
b Pregnancy/Child Birth Complications            
141 Ectopic Pregnancy 0 - 0 - 0 -
142 Miscarriage/Abortion 3 0.0 1 0.1 0 -
143 Completed Pregnancy With Major Complications 0 - 1 0.1 0 -
144 Completed Pregnancy With Complications 6 0.1 0 - 0 -
145 Completed Pregnancy Without Complications (Normal Delivery) 3 0.0 1 0.1 0 -
146 Uncompleted Pregnancy With Complications 4 0.0 1 0.1 0 -
147 Uncompleted Pregnancy With No or Minor Complications 7 0.1 1 0.1 0 -
168 Extremely Low Birthweight Neonates 0 - 0 - 0 -
169 Very Low Birthweight Neonates 0 - 0 - 0 -
170 Serious Perinatal Problem Affecting Newborn 111 1.3 15 1.0 11 0.6
171 Other Perinatal Problems Affecting Newborn 21 0.3 2 0.1 2 0.1
172 Normal, Single Birth 4 0.0 1 0.1 1 0.1
  Dermatological Disorders            
148 Decubitus Ulcer of Skin 54 0.7 11 0.8 3 0.2
149 Chronic Ulcer of Skin, Except Decubitus 21 0.3 5 0.3 4 0.2
150 Extensive Third-Degree Burns 0 - 0 - 0 -
151 Other Third-Degree & Extensive Burns 3 0.0 0 - 0 -
152 Cellulitis, Local Skin Infection 313 3.8 53 3.6 53 2.9
153 Other Dermatological Disorders 969 11.7 144 9.9 150 8.2
  Fractures, Other Injuries, and Poisoning            
154 Severe Head Injury 4 0.0 0 - 0 -
155 Major Head Injury 54 0.7 6 0.4 15 0.8
156 Concussion or Unspecified Head Injury 81 1.0 12 0.8 20 1.1
157 Vertebral Fractures without Spinal Cord Injury 1 0.0 1 0.1 3 0.2
158 Hip Fracture/Dislocation 105 1.3 10 0.7 25 1.4
159 Major Fracture, Except of Skull, Vertebrae, or Hip 90 1.1 13 0.9 21 1.1
160 Internal Injuries 7 0.1 1 0.1 3 0.2
161 Traumatic Amputation 9 0.1 2 0.1 0 -
162 Other Injuries 872 10.5 138 9.5 177 9.6
163 Poisonings & Allergic Reactions 135 1.6 15 1.0 23 1.3
b,c Treatment Complications and Status            
164 Major Complications of Medical Care & Trauma 280 3.4 40 2.7 36 2.0
165 Other Complications of Medical Care 83 1.0 18 1.2 9 0.5
166 Major Symptoms, Abnormalities 2,489 30.0 385 26.5 392 21.4
167 Minor Symptoms, Signs, Findings 1,686 20.3 243 16.7 277 15.1
174 Major Organ Transplant Status 41 0.5 2 0.1 3 0.2
175 Other Organ Transplant, Replacement 46 0.6 5 0.3 3 0.2
176 Artificial Openings for Feeding or Elimination 377 4.5 52 3.6 49 2.7
177 Amputation Status, Lower Limb/Amputation Complications 4 0.0 0 - 1 0.1
178 Amputation Status, Upper Limb 0 - 0 - 0 -
179 Post-Surgical States/Aftercare/Elective 1,034 12.5 121 8.3 140 7.6
  Miscellaneous            
180 Radiation Therapy 9 0.1 1 0.1 0 -
181 Chemotherapy 21 0.3 1 0.1 1 0.1
182 Rehabilitation 81 1.0 14 1.0 20 1.1
183 Screening/Observation/Special Exams 2,240 27.0 334 23.0 356 19.4
184 History of Disease 52 0.6 3 0.2 7 0.4
Parent is paid as an IHSS worker for their minor child, Other Relatives (other than spouse or parent) paid as an IHSS worker for recipient, Non-Relatives refers to all other paid IHSS workers for recipient.

HCC refers to the CMS hierarchical condition categories or CMS-HCC model (Pope, Kautter, Ellis, et al., 2004). The HCC provide an established standardized protocol for combining International Classification of Disease (CDC, 2007) or ICD-9 diagnostic codes. HCC’s aggregate the over 15,000 ICD-9 categories into 189 condition categories (CCs), five of which are based on beneficiary utilization of selected types of durable medical equipment (Pope, Ellis, Ash, et al., 2000). The CCs describe a broad set of similar diseases, generally organized into body systems. Another advantage is that the CCs hierarchies are designed so that a person is coded only for the most severe manifestation among the related diseases defining the CC. Within the same HCC a person is classified once. This avoids duplicative counting of related conditions. For unrelated diseases (i.e., diseases in other CCs), the number of HCC’s accumulate.
  1. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 20 in the HCC ICD-9 code file.
  2. The inconsistent number sequence within "Pregnancy/Child Birth Complications" is a result of how the contractor grouped HCCs into the body systems structure used in this table.
  3. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 173 in the HCC ICD-9 code file.


TABLE D-2: Hierarchical Condition Classification Distribution for IHSS Recipients, Age 18-64 by Provider Relationship, 2005
HCC Spouse Parent Other Relatives Non-Relative
# % # % # % # %
  Total Recipients   6,721     100.0     18,749     100.0     40,603     100.0     59,429     100.0  
  Recipients w/ any HCC 6,003 89.3 13,789 73.5 36,362 89.6 52,197 87.8
 
  Infections and Parasitic Disease                
1 HIV/AIDS 55 0.8 222 1.2 523 1.3 1,987 3.3
2 Septicemia/Shock 198 2.9 280 1.5 861 2.1 1,283 2.2
3 Central Nervous System Infection 48 0.7 75 0.4 148 0.4 288 0.5
4 Tuberculosis 18 0.3 46 0.2 127 0.3 148 0.2
5 Opportunistic Infections 30 0.4 42 0.2 96 0.2 161 0.3
6 Other Infectious Diseases 508 7.6 1,139 6.1 3,119 7.7 4,927 8.3
  Neoplasms                
7 Metastatic Cancer and Acute Leukemia 117 1.7 78 0.4 556 1.4 573 1.0
8 Lung, Upper Digestive Tract, and Other Severe Cancers 114 1.7 54 0.3 569 1.4 726 1.2
9 Lymphatic, Head and Neck, Brain, and Other Major Cancers 154 2.3 165 0.9 658 1.6 914 1.5
10 Breast, Prostate, Colorectal and Other Cancers and Tumors 265 3.9 253 1.3 1,589 3.9 1,931 3.2
11 Other Respiratory and Heart Neoplasms 36 0.5 25 0.1 149 0.4 183 0.3
12 Other Digestive and Urinary Neoplasms 216 3.2 137 0.7 1,115 2.7 1,568 2.6
13 Other Neoplasms 172 2.6 207 1.1 1,188 2.9 1,838 3.1
14 Benign Neoplasms of Skin, Breast, Eye 174 2.6 315 1.7 1,991 4.9 2,589 4.4
a Endocrine, Nutritional and Metabolic Disorders                
15 Diabetes with Renal or Peripheral Circulatory Manifestation 231 3.4 108 0.6 897 2.2 881 1.5
16 Diabetes with Neurologic or Other Specified Manifestation 322 4.8 213 1.1 1,608 4.0 1,984 3.3
17 Diabetes with Acute Complications 39 0.6 61 0.3 221 0.5 331 0.6
18 Diabetes with Ophthalmologic or Unspecified Manifestation 206 3.1 117 0.6 1,078 2.7 1,214 2.0
19 Diabetes without Complication 1,383 20.6 958 5.1 7,830 19.3 8,880 14.9
21 Protein-Calorie Malnutrition 32 0.5 47 0.3 92 0.2 162 0.3
22 Other Significant Endocrine and Metabolic Disorders 89 1.3 216 1.2 469 1.2 623 1.0
23 Disorders of Fluid/Electrolyte/Acid-Base Balance 182 2.7 272 1.5 999 2.5 1,408 2.4
24 Other Endocrine/Metabolic/ Nutritional Disorders 837 12.5 1,350 7.2 5,987 14.7 7,459 12.6
  Liver and Gallbladder Disease                
25 End-Stage Liver Disease 77 1.1 50 0.3 318 0.8 453 0.8
26 Cirrhosis of Liver 136 2.0 97 0.5 619 1.5 897 1.5
27 Chronic Hepatitis 153 2.3 154 0.8 628 1.5 1,321 2.2
28 Acute Liver Failure/Disease 12 0.2 24 0.1 93 0.2 160 0.3
29 Other Hepatitis and Liver Disease 271 4.0 278 1.5 1,357 3.3 2,235 3.8
30 Gallbladder and Biliary Tract Disorders 106 1.0 158 0.8 771 1.9 897 1.5
  Gastrointestinal Disease                
31 Intestinal Obstruction/Perforation 108 1.6 211 1.1 576 1.4 817 1.4
32 Pancreatic Disease 74 1.1 111 0.6 443 1.1 689 1.2
33 Inflammatory Bowel Disease 22 0.3 55 0.3 142 0.3 260 0.4
34 Peptic Ulcer, Hemorrhage, Other Specified Gastrointestinal Disorders 348 5.2 383 2.0 2,015 5.0 2,485 4.2
35 Appendicitis 11 0.2 27 0.1 50 0.1 61 0.1
36 Other Gastrointestinal Disorders 1,438 21.4 2,207 11.8 8,714 21.5 11,943 20.1
  Musculoskeletal/Connective Tissue                
37 Bone/Joint/Muscle Infections/Necrosis 111 1.7 176 0.9 457 1.1 905 1.5
38 Rheumatoid Arthritis and Inflammatory Connective Tissue Disease 181 2.7 276 1.5 1,397 3.4 1,857 3.1
39 Disorders of the Vertebrae and Spinal Discs 561 8.3 564 3.0 3,535 8.7 5,652 9.5
40 Osteoarthritis of Hip or Knee 181 2.7 150 0.8 1,671 4.1 2,266 3.8
41 Osteoporosis and Other Bone/Cartilage Disorders 235 3.5 338 1.8 2,025 5.0 2,385 4.0
42 Congenital/Developmental Skeletal and Connective Tissue Disorders 7 0.1 49 0.3 32 0.1 92 0.2
43 Other Musculoskeletal and Connective Tissue Disorders 2,533 37.7 3,363 17.9 17,451 43.0 25,016 42.1
  Diseases of the Blood and Blood Forming Organs                
44 Severe Hematological Disorders 47 0.7 114 0.6 298 0.7 459 0.8
45 Disorders of Immunity 7 0.1 37 0.2 32 0.1 113 0.2
46 Coagulation Defects and Other Specified Hematological Disorders 71 1.1 125 0.7 381 0.9 569 1.0
47 Iron Deficiency and Other/Unspecified Anemias and Blood Disease 466 6.9 568 3.0 2,649 6.5 3,344 5.6
  Mental Disorders                
48 Delirium and Encephalopathy 56 0.8 187 1.0 319 0.8 522 0.9
49 Dementia/Cerebral Degeneration 128 1.9 241 1.3 553 1.4 767 1.3
50 Nonpsychotic Organic Brain Syndromes/Conditions 66 1.0 127 0.7 346 0.9 502 0.8
51 Drug/Alcohol Psychosis 13 0.2 46 0.2 130 0.3 397 0.7
52 Drug/Alcohol Dependence 33 0.5 56 0.3 209 0.5 602 1.0
53 Drug/Alcohol Abuse, Without Dependence 38 0.6 106 0.6 330 0.8 887 1.5
54 Schizophrenia 45 0.7 464 2.5 654 1.6 1,367 2.3
55 Major Depressive, Bipolar, and Paranoid Disorders 119 1.8 344 1.8 1,048 2.6 2,375 4.0
56 Reactive and Unspecified Psychosis 44 0.7 192 1.0 320 0.8 627 1.1
57 Personality Disorders 3 0.0 17 0.1 32 0.1 104 0.2
58 Depression 130 1.9 256 1.4 1,072 2.6 1,921 3.2
59 Anxiety Disorders 56 0.8 152 0.8 389 1.0 787 1.3
60 Other Psychiatric Disorders 199 3.0 452 2.4 1,313 3.2 2,492 4.2
  Mental Retardation/ Developmental Disability                
61 Profound Mental Retardation/Developmental Disability 1 0.0 92 0.5 16 0.0 46 0.1
62 Severe Mental Retardation/Developmental Disability - - 43 0.2 11 0.0 21 0.0
63 Moderate Mental Retardation/Developmental Disability - - 44 0.2 26 0.1 19 0.0
64 Mild Mental Retardation, Autism, Down's Syndrome 12 0.2 826 4.4 277 0.7 422 0.7
65 Other Developmental Disability 2 0.0 164 0.9 41 0.1 106 0.2
66 Attention Deficit Disorder 4 0.1 42 0.2 23 0.1 73 0.1
  Central Nervous System Injuries/Disorders                
67 Quadriplegia, Other Extensive Paralysis 65 1.0 443 2.4 145 0.4 487 0.8
68 Paraplegia 67 1.0 281 1.5 217 0.5 497 0.8
69 Spinal Cord Disorders/Injuries 84 1.2 427 2.3 318 0.8 650 1.1
70 Muscular Dystrophy 20 0.3 145 0.8 45 0.1 110 0.2
71 Polyneuropathy 13 2.1 15 0.8 574 1.4 1,031 1.7
72 Multiple Sclerosis 88 1.3 158 0.8 265 0.7 690 1.2
73 Parkinson's and Huntington's Diseases 62 0.9 49 0.3 175 0.4 236 0.4
74 Seizure Disorders and Convulsions 379 5.6 2,359 12.6 2,002 4.9 3,741 6.3
75 Coma, Brain Compression/Anoxic Damage 22 0.3 68 0.4 104 0.3 166 0.3
76 Mononeuropathy, Other Neurological Conditions/Injuries 341 5.1 573 3.1 2,211 5.4 3,469 5.8
  Respiratory System Disorders                
77 Respirator Dependence/Tracheostomy Status 19 0.3 105 0.6 86 0.2 158 0.3
78 Respiratory Arrest 12 0.2 18 0.1 52 0.1 75 0.1
79 Cardio-Respiratory Failure and Shock 268 4.0 425 2.3 1,364 3.4 2,008 3.4
  Cardiovascular System                
80 Congestive Heart Failure 586 8.7 481 2.6 3,331 8.2 4,258 7.2
81 Acute Myocardial Infarction 74 1.1 38 0.2 369 0.9 406 0.7
82 Unstable Angina and Other Acute Ischemic Heart Disease 179 2.7 71 0.4 1,099 2.7 1,269 2.1
83 Angina Pectoris/Old Myocardial Infarction 170 2.5 77 0.4 1,342 3.3 1,207 2.0
84 Coronary Atherosclerosis/Other Chronic Ischemic Heart Disease 635 9.4 200 1.1 3,414 8.4 3,718 6.3
85 Heart Infection/Inflammation, Except Rheumatic 46 0.7 44 0.2 237 0.6 301 0.5
86 Valvular and Rheumatic Heart Disease 367 5.5 359 1.9 2,326 5.7 2,623 4.4
87 Major Congenital Cardiac/Circulatory Defect 1 0.0 30 0.2 20 0.0 23 0.0
88 Other Congenital Heart/Circulatory Disease 26 0.4 109 0.6 181 0.4 220 0.4
89 Hypertensive Heart and Renal Disease or Encephalopathy 33 0.5 20 0.1 168 0.4 162 0.3
90 Hypertensive Heart Disease 140 2.1 89 0.5 1,290 3.2 1,229 2.1
91 Hypertension 1,366 20.3 1,089 5.8 10,511 25.9 11,700 19.7
92 Specified Heart Arrhythmias 221 3.3 182 1.0 1,279 3.2 1,700 2.9
93 Other Heart Rhythm and Conduction Disorders 313 4.7 312 1.7 1,784 4.4 2,333 3.9
94 Other and Unspecified Heart Disease 308 4.6 283 1.5 1,763 4.3 2,295 3.9
  Cerebral and Other Vascular Systems                
95 Cerebral Hemorrhage 49 0.7 63 0.3 219 0.5 269 0.5
96 Ischemic or Unspecified Stroke 367 5.5 195 1.0 1,324 3.3 1,635 2.8
97 Precerebral Arterial Occlusion and Transient Cerebral Ischemia 239 3.6 139 0.7 1,252 3.1 1,436 2.4
98 Cerebral Atherosclerosis and Aneurysm 37 0.6 33 0.2 199 0.5 264 0.4
99 Cerebrovascular Disease, Unspecified 19 0.3 26 0.1 94 0.2 139 0.2
100 Hemiplegia/Hemiparesis 114 1.7 154 0.8 279 0.7 522 0.9
101 Cerebral Palsy and Other Paralytic Syndromes 39 0.6 755 4.0 263 0.6 667 1.1
102 Speech, Language, Cognitive, Perceptual Deficits 29 0.4 35 0.2 110 0.3 189 0.3
103 Cerebrovascular Disease Late Effects, Unspecified 48 0.7 24 0.1 168 0.4 226 0.4
104 Vascular Disease with Complications 134 2.0 111 0.6 622 1.5 806 1.4
105 Vascular Disease 386 5.7 256 1.4 2,181 5.4 2,650 4.5
106 Other Circulatory Disease 362 5.4 332 1.8 1,838 4.5 2,467 4.2
  Pulmonary System                
107 Cystic Fibrosis 3 0.0 15 0.1 20 0.0 25 0.0
108 Chronic Obstructive Pulmonary Disease 470 7.0 427 2.3 3,516 8.7 5,731 9.6
109 Fibrosis of Lung and Other Chronic Lung Disorders 141 2.1 207 1.1 803 2.0 1,179 2.0
110 Asthma 325 4.8 557 3.0 2,507 6.2 3,806 6.4
111 Aspiration and Specified Bacterial Pneumonias 72 1.1 183 1.0 299 0.7 479 0.8
112 Pneumococcal Pneumonia, Empyema, Lung Abscess 49 0.7 80 0.4 212 0.5 345 0.6
113 Viral and Unspecified Pneumonia, Pleurisy 488 7.3 807 4.3 2,536 6.2 3,684 6.2
114 Pleural Effusion/Pneumothorax 156 2.3 181 1.0 787 1.9 1,033 1.7
115 Other Lung Disorders 923 13.7 1,630 8.7 5,748 14.2 7,757 13.1
  Eyes and Vision Disorders                
116 Legally Blind 11 0.2 27 0.1 50 0.1 104 0.2
117 Major Eye Infections/Inflammations 9 0.1 23 0.1 49 0.1 88 0.1
118 Retinal Detachment 24 0.4 38 0.2 123 0.3 145 0.2
119 Proliferative Diabetic Retinopathy and Vitreous Hemorrhage 144 2.1 43 0.2 523 1.3 440 0.7
120 Diabetic and Other Vascular Retinopathies 137 2.0 53 0.3 744 1.8 703 1.2
121 Retinal Disorders, Except Detachment and Vascular Retinopathies 79 1.2 44 0.2 399 1.0 447 0.8
122 Glaucoma 240 3.6 184 1.0 1,458 3.6 1,675 2.8
123 Cataract 282 4.2 152 0.8 2,063 5.1 2,072 3.5
124 Other Eye Disorders 672 10.0 1,145 6.1 5,236 12.9 5,736 9.7
  Ears, Nose, and Throat Disorders                
125 Significant Ear, Nose, and Throat Disorders 32 0.5 39 0.2 192 0.5 258 0.4
126 Hearing Loss 57 0.8 141 0.8 373 0.9 628 1.1
127 Other Ear, Nose, Throat, and Mouth Disorders 1,315 19.6 3,826 20.4 8,381 20.6 11,597 19.5
  Renal System                
128 Kidney Transplant Status 65 1.0 86 0.5 207 0.5 225 0.4
130 Dialysis Status 257 3.8 181 1.0 849 2.1 824 1.4
131 Renal Failure 742 11.0 485 2.6 2,549 6.3 2,686 4.5
132 Nephritis 37 0.6 46 0.2 177 0.4 180 0.3
  Other Genitourinary System                
133 Urinary Obstruction and Retention 328 4.9 706 3.8 1,307 3.2 2,063 3.5
134 Incontinence 70 1.0 162 0.9 545 1.3 783 1.3
135 Urinary Tract Infection 543 8.1 1,064 5.7 3,114 7.7 4,629 7.8
136 Other Urinary Tract Disorders 394 5.9 454 2.4 1,842 4.5 2,347 3.9
137 Female Infertility - - 1 0.0 3 0.0 8 0.0
138 Pelvic Inflammatory Disease and Other Specified Female Genital Disorders 78 1.2 159 0.8 662 1.6 821 1.4
139 Other Female Genital Disorders 279 4.2 718 3.8 3,302 8.1 4,013 6.8
140 Male Genital Disorders 232 3.5 201 1.1 719 1.8 1,206 2.0
b Pregnancy/Child Birth Complications                
141 Ectopic Pregnancy 4 0.1 2 0.0 6 0.0 6 0.0
142 Miscarriage/Abortion 10 0.1 34 0.2 47 0.1 110 0.2
143 Completed Pregnancy With Major Complications 5 0.1 17 0.1 14 0.0 35 0.1
144 Completed Pregnancy With Complications 11 0.2 38 0.2 38 0.1 115 0.2
145 Completed Pregnancy Without Complications (Normal Delivery) 13 0.2 41 0.2 35 0.1 105 0.2
146 Uncompleted Pregnancy w/complications 13 0.2 35 0.2 39 0.1 116 0.2
147 Uncompleted Pregnancy With No or Minor Complications 31 0.5 98 0.5 103 0.3 268 0.5
168 Extremely Low Birthweight Neonates 2 0.0 - - 1 0.0 1 0.0
169 Very Low Birthweight Neonates - - 1 0.0 1 0.0 2 0.0
170 Serious Perinatal Problem Affecting Newborn 4 0.1 18 0.1 30 0.1 57 0.1
171 Other Perinatal Problems Affecting Newborn 3 0.0 18 0.1 29 0.1 48 0.1
172 Normal, Single Birth 13 0.2 41 0.2 35 0.1 108 0.2
  Dermatological Disorders                
148 Decubitus Ulcer of Skin 93 1.4 266 1.4 351 0.9 819 1.4
149 Chronic Ulcer of Skin, Except Decubitus 199 3.0 248 1.3 826 2.0 1,366 2.3
150 Extensive Third-Degree Burns - - - - - - 7 0.0
151 Other Third-Degree and Extensive Burns 6 0.1 6 0.0 16 0.0 55 0.1
152 Cellulitis, Local Skin Infection 496 7.4 934 5.0 2,720 6.7 5,032 8.5
153 Other Dermatological Disorders 647 9.6 1,716 9.2 4,779 11.8 7,398 12.4
  Fractures, Other Injuries and Poisoning                
154 Severe Head Injury 2 0.0 9 0.0 10 0.0 24 0.0
155 Major Head Injury 46 0.7 169 0.9 215 0.5 440 0.7
156 Concussion or Unspecified Head Injury 82 1.2 177 0.9 445 1.1 858 1.4
157 Vertebral Fractures without Spinal Cord Injury 30 0.4 41 0.2 181 0.4 351 0.6
158 Hip Fracture/Dislocation 47 0.7 101 0.5 268 0.7 595 1.0
159 Major Fracture, Except of Skull, Vertebrae, or Hip 92 1.4 172 0.9 515 1.3 1,037 1.7
160 Internal Injuries 14 0.2 38 0.2 81 0.2 141 0.2
161 Traumatic Amputation 60 0.9 62 0.3 175 0.4 296 0.5
162 Other Injuries 1,033 15.4 1,932 10.3 6,048 14.9 11,126 18.7
163 Poisonings and Allergic Reactions 186 2.8 340 1.8 948 2.3 1,795 3.0
b,c Treatment Complications and Status                
164 Major Complications of Medical Care and Trauma 298 4.4 444 2.4 1,217 3.0 1,805 3.0
165 Other Complications of Medical Care 113 1.7 183 1.0 572 1.4 911 1.5
166 Major Symptoms, Abnormalities 2,756 41.0 3,993 21.3 16,897 41.6 23,250 39.1
167 Minor Symptoms, Signs, Findings 2,318 34.5 3,609 19.2 14,745 36.3 20,037 33.7
174 Major Organ Transplant Status 52 0.8 55 0.3 140 0.3 165 0.3
175 Other Organ Transplant/Replacement 29 0.4 39 0.2 103 0.3 109 0.2
176 Artificial Openings for Feeding or Elimination 81 1.2 245 1.3 280 0.7 422 0.7
177 Amputation Status, Lower Limb/Amputation Complications 44 0.7 35 0.2 137 0.3 229 0.4
178 Amputation Status, Upper Limb - - - - 2 0.0 4 0.0
179 Post-Surgical States/Aftercare/Elective 563 8.4 994 5.3 2,715 6.7 4,531 7.6
  Miscellaneous                
180 Radiation Therapy 25 0.4 17 0.1 154 0.4 190 0.3
181 Chemotherapy 5 0.1 14 0.1 70 0.2 74 0.1
182 Rehabilitation 205 3.1 273 1.5 772 1.9 1,488 2.5
183 Screening/Observation/Special Exams 1,969 29.3 3,924 20.9 13,199 32.5 18,994 32.0
184 History of Disease 100 1.5 95 0.5 495 1.2 753 1.3
Parent is paid as an IHSS worker for their adult child, Spouse is paid as an IHSS worker for recipient, Other Relatives (other than spouse or parent) paid as an IHSS worker for recipient, Non-Relatives refers to all other paid IHSS workers for recipient.

HCC refers to the CMS hierarchical condition category or CMS-HCC model (Pope, Kautter, Ellis, et al., 2004). The HCC provide an established standardized protocol for combining International Classification of Disease (CDC, 2007) or ICD-9 diagnostic codes. HCCs aggregate the over 15,000 ICD-9 categories into 189 condition categories (CCs), five of which are based on beneficiary utilization of selected types of durable medical equipment (Pope, Ellis, Ash, et al., 2000). The CCs describe a broad set of similar diseases, generally organized into body systems. Another advantage is that the CC hierarchies are designed so that a person is coded only for the most severe manifestation among the related diseases defining the CC. Within the same HCC a person is classified once. This avoids duplicative counting of related conditions. For unrelated diseases (i.e., diseases in other CCs), the number of HCCs accumulate.
  1. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 20 in the HCC ICD-9 code file.
  2. The inconsistent number sequence within "Pregnancy/Child Birth Complications" is a result of how the contractor grouped HCCs into the body systems structure used in this table.
  3. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 173 in the HCC ICD-9 code file.


TABLE D-3: Hierarchical Condition Classification Distribution for IHSS Recipients Age 65+ by Provider Relationship, 2005
HCC Parents Other Relative Non-Relative
# % # % # %
  Total Recipients   4,656     100.0     109,260     100.0     95,551     100.0  
  Recipients w/any HCC 3,847 82.6 91,221 83.5 80,167 83.9
 
  Infections and Parasitic Disease            
1 HIV/AIDS 3 0.1 27 0.0 75 01
2 Septicemia/Shock 119 2.6 1,781 1.6 1,389 1.5
3 Central Nervous System Infection 9 0.2 96 0.1 107 0.1
4 Tuberculosis 14 0.3 192 0.2 106 0.1
5 Opportunistic Infections 14 0.3 94 0.1 75 0.1
6 Other Infectious Diseases 192 4.1 4,263 3.9 5,017 5.3
  Neoplasms            
7 Metastatic Cancer and Acute Leukemia 65 1.4 971 0.9 868 0.9
8 Lung, Upper Digestive Tract, and Other Severe Cancers 97 2.1 1,572 1.4 1,436 1.5
9 Lymphatic, Head and Neck, Brain, and Other Major Cancers 82 1.8 1,182 1.1 1,078 1.1
10 Breast, Prostate, Colorectal and Other Cancers and Tumors 259 5.6 4,206 3.8 4,107 4.3
11 Other Respiratory and Heart Neoplasms 24 0.5 237 0.2 234 0.2
12 Other Digestive and Urinary Neoplasms 167 3.6 3,271 3.0 3,170 3.3
13 Other Neoplasms 56 1.2 1,435 1.3 1,665 1.7
14 Benign Neoplasms of Skin, Breast, Eye 45 1.0 2,181 2.0 2,589 2.7
a Endocrine, Nutritional and Metabolic Disorders            
15 Diabetes with Renal or Peripheral Circulatory Manifestation 109 2.3 1,171 1.1 1,010 1.1
16 Diabetes with Neurologic or Other Specified Manifestation 178 3.8 2,181 2.0 1,919 2.0
17 Diabetes with Acute Complications 8 0.2 161 0.1 153 0.2
18 Diabetes with Ophthalmologic or Unspecified Manifestation 78 1.7 915 0.8 762 0.8
19 Diabetes without Complication 580 12.5 9,905 9.1 8,322 8.7
21 Protein-Calorie Malnutrition 14 0.3 186 0.2 140 0.1
22 Other Significant Endocrine and Metabolic Disorders 25 0.5 341 0.3 318 0.3
23 Disorders of Fluid/Electrolyte/Acid-Base Balance 103 2.2 1,529 1.4 1,406 1.5
24 Other Endocrine/Metabolic/Nutritional Disorders 217 4.7 5,687 5.2 5,007 5.2
  Liver and Gallbladder Disease            
25 End-Stage Liver Disease 18 0.4 186 0.2 142 0.1
26 Cirrhosis of Liver 39 0.8 384 0.4 321 0.3
27 Chronic Hepatitis 14 0.3 198 0.2 174 0.2
28 Acute Liver Failure/Disease 5 0.1 61 0.1 49 0.1
29 Other Hepatitis and Liver Disease 60 1.3 1,050 1.0 844 0.9
30 Gallbladder and Biliary Tract Disorders 73 1.6 1,383 1.3 1,128 1.2
  Gastrointestinal Disease/Disorders            
31 Intestinal Obstruction/Perforation 77 1.7 1,096 1.0 1,083 1.1
32 Pancreatic Disease 41 0.9 651 0.6 590 0.6
33 Inflammatory Bowel Disease 12 0.3 147 0.1 160 0.2
34 Peptic Ulcer, Hemorrhage, Other Specified Gastrointestinal Disorders 194 4.2 3,758 3.4 3,435 3.6
35 Appendicitis 5 0.1 79 0.1 65 0.1
36 Other Gastrointestinal Disorders 669 14.4 14,064 12.9 13,445 14.1
  Musculoskeletal/Connective Tissue Disease/Disorders            
37 Bone/Joint/Muscle Infections/Necrosis 50 1.1 473 0.4 434 0.5
38 Rheumatoid Arthritis & Inflammatory Connective Tissue Disease 57 1.2 1,032 0.9 1,171 1.2
39 Disorders of the Vertebrae and Spinal Discs 238 5.1 5,441 5.0 5,940 6.2
40 Osteoarthritis of Hip or Knee 102 2.2 3,567 3.3 3,467 3.6
41 Osteoporosis and Other Bone/Cartilage Disorders 89 1.9 3,471 3.2 3,321 3.5
42 Congenital/Developmental Skeletal and Connective Tissue Disorders 1 0.0 19 0.0 20 0.0
43 Other Musculoskeletal and Connective Tissue Disorders 1,037 22.3 28,437 26.0 27,887 29.2
  Blood and Blood Forming Organ Disease/Disorders            
44 Severe Hematological Disorders 32 0.7 5 0.6 470 0.5
45 Disorders of Immunity 1 0.0 16 0.0 19 0.0
46 Coagulation Defects and Other Specified Hematological Disorders 22 0.5 390 0.4 393 0.4
47 Iron Deficiency and Other/Unspecified Anemias and Blood Disease 239 5.1 4,647 4.3 4,316 4.5
  Mental Disorders            
48 Delirium and Encephalopathy 18 0.4 293 0.3 298 0.3
49 Dementia/Cerebral Degeneration 167 3.6 3,510 3.2 3,091 3.2
50 Nonpsychotic Organic Brain Syndromes/Conditions 30 0.6 570 0.5 517 0.5
51 Drug/Alcohol Psychosis 5 0.1 42 0.0 89 0.1
52 Drug/Alcohol Dependence 4 0.1 28 0.0 83 0.1
53 Drug/Alcohol Abuse, Without Dependence 7 0.2 82 0.1 151 0.2
54 Schizophrenia 5 0.1 133 0.1 186 0.2
55 Major Depressive, Bipolar, and Paranoid Disorders 23 0.5 711 0.7 936 1.0
56 Reactive and Unspecified Psychosis 18 0.4 319 0.3 301 0.3
57 Personality Disorders - - 8 0.0 12 0.0
58 Depression 19 0.4 488 0.4 546 0.6
59 Anxiety Disorders 5 0.1 144 0.1 186 0.2
60 Other Psychiatric Disorders 25 0.5 678 0.6 867 0.9
  Mental Retardation/Developmental Disability            
61 Profound Mental Retardation/Developmental Disability - - 2 0.0 2 0.0
62 Severe Mental Retardation/Developmental Disability - - 3 0.0 - -
63 Moderate Mental Retardation/Developmental Disability - - - - - -
64 Mild Mental Retardation, Autism, Down's Syndrome - - 16 0.0 9 0.0
65 Other Developmental Disability 1 0.0 8 0.0 13 0.0
66 Attention Deficit Disorder - - 5 0.0 9 0.0
  Central Nervous System Injuries/Disorders            
67 Quadriplegia, Other Extensive Paralysis 5 0.1 42 0.0 36 0.0
68 Paraplegia 7 0.2 37 0.0 43 0.0
69 Spinal Cord Disorders/Injuries 17 0.4 299 0.3 266 0.3
70 Muscular Dystrophy - - 4 0.0 9 0.0
71 Polyneuropathy 33 0.7 430 0.4 446 0.5
72 Multiple Sclerosis 6 0.1 30 0.0 60 0.1
73 Parkinson's and Huntington's Diseases 60 1.3 569 0.5 493 0.5
74 Seizure Disorders and Convulsions 56 1.2 897 0.8 784 0.8
75 Coma, Brain Compression/Anoxic Damage 2 0.0 86 0.1 79 0.1
76 Mononeuropathy, Other Neurological Conditions/Injuries 82 1.8 1,413 1.3 1,560 1.6
  Respiratory System Disorders