This is the final report of a project that assesses the need for developing and fielding another national disability survey data collection effort. It presents the findings from three principal project activities designed to assess whether existing data are sufficient to answer key disability-related research questions identified by the staffs of
Developing Medicare and Medicaid Substance Abuse Treatment Spending Estimates. C. Part C: Medicare Advantage
Because encounter data reporting is not mature for MA enrolled beneficiaries, we propose initially estimating SA treatment expenditures for the MA population based on the average level of expenditures for non-MA enrolled Medicare beneficiaries with similar characteristics. As complete encounter data become available for MA enrollees, the second ap
Developing Medicare and Medicaid Substance Abuse Treatment Spending Estimates. I. Proposed Methodology for Producing Medicare Substance Abuse Treatment Expenditures Estimates
In this section, we propose a methodology for developing estimates of Medicare SA treatment spending. The methods parallel the approach used to develop Medicaid spending estimates in this project. In Section A , we provide an overview of Medicare coverage of SA treatment services and the payment approaches Medicare uses to reimburse providers for
This is a supplemental report to the final report of a study jointly funded by ONDCP and ASPE (Medicaid Substance Abuse Treatment Spending: Findings Report). This technical report provides more detail on the methods used to make estimates, and it also describes how MPR would make similar estimates of Medicare funding for substance abuse treatment,
Saucier P., Kasten J., Burwell B., and Gold L. 2012. The Growth of Managed Long Term Services and Supports (MLTSS) Programs: A 2012 Update . Centers for Medicare and Medicaid Services. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/MLTSSP_White_paper_combined.pdf . Accessed August 8, 2013.
This report explores how several states have designed their quality monitoring and improvement programs for managed long-term services and supports (MLTSS). The authors focus on the early adopters of MLTSS as well as those programs that are presented considered "established". The findings demonstrate how states take somewhat different approaches
Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Appendix K. New York Medicaid Advantage Plus
Element Description/Notes State and Lead Agency New York State Department of Health (SDOH), Division of Long-Term Care
Environmental Scan of MLTSS Quality Requirements in MCO Contracts. Appendix C. Florida Long-term CARE Community Diversion Pilot Project
Element Description/Notes State and Lead Agency Florida Department of Elder Affairs Contract covering 2012 through August 2013
This report describes how frequently various quality requirement elements appear in managed care organization contracts, as well as some similarities and differences in the quality requirements.
Understanding the High Prevalence of Low-Prevalence Chronic Disease Combinations: Databases and Methods for Research. Centers for Medicare & Medicaid Services Grouper Systems
Hierarchical Condition Categories (HCC) References:
Understanding the High Prevalence of Low-Prevalence Chronic Disease Combinations: Databases and Methods for Research. Centers for Medicare & Medicaid Services Datasets
CMS Chronic Conditions Warehouse References: Chronic Conditions Data Warehouse. 2013. https://www.ccwdata.org/web/guest/home
Within the Microsoft Access relational database, each filing corresponds to a single data entry form. Analysts used this database of filings to capture the analytic variables from each PDF filing. Similar to the data extraction phase, NORC used pre-populated drop-down menus to reduce transcription error for quality control/quality assurance purpos
Most of this issue brief has focused on the traditional Medicare program due to the availability of Medicare claims data to analyze service category level spending trends.
The rate of national health care spending growth per person has been on a downward trajectory in recent years (see Figure 1). This downward trend has been especially significant for the Medicare program since 2009.
To build a national database, NORC attempted to collect rate filings submitted by issuers of comprehensive major medical insurance products to state regulators from 2008 to 2011. 15 As noted above, to our knowledge, this is the first study that attempts to build a national database of carrier rate filings. As a result, NORC and its subcontractor,
Data for this study was provided by the National Association of Insurance Commissioners (NAIC). The data are based on reporting by insurers to state departments of insurance, and exclude data for companies that are regulated by the California Department of Managed Health Care (DMHC).
We find that Medigap premiums have risen moderately on average over the past decade and in particular since 2007. From 2001 to 2010 Medigap premiums increased at an average annual rate of 3.8 percent, while Medicare spending per beneficiary increased by 5.4 percent. In six of the past nine years, Medigap premium increases have been smaller than th
Using all Medigap plans that had usable data in each of the four years from 2007 and 2010, we estimated a model to predict annual changes in premiums within plans. Important findings are:
In 2010, according to data filed by insurers with the National Association of Insurance Commissioners, 9.6 million Medicare beneficiaries (about 20 percent of all beneficiaries) purchased supplemental coverage through Medigap. 12 As displayed in Figure 2, the percentage of Medicare beneficiaries enrolled in Medigap plans declined over the past de
While Medicare covers many services, it does not cover them in full. Individuals with Medicare coverage are responsible for some out‐of‐pocket expenses such as copayments, coinsurance, and deductibles (see Appendix A for more information). Fee‐for‐service Medicare also does not include a cap on out‐of‐pocket payments. Medigap (also cal