Association between NCQA Patient-Centered Medical Home Recognition for Primary Care Practices and Quality of Care for Children with Disabilities and Special Health Care Needs. APPENDIX A: State Selection

01/01/2014

We first assessed the number of NCQA-recognized child-serving pediatric practices and providers in each state. To identify child-serving providers, we merged the NCQA provider-level data, by NPI, to CMS' National Plan and Provider Enumeration System (NPPES) file. The NCQA file contained data on the specialty of most providers in the data set, but data were missing for approximately 20 percent of the sample. We compared the specialty as provided by NCQA with the primary specialty as reported in the NPPES file, and flagged those NCQA-recognized providers as serving children if either NCQA or NPPES primary specialty variables included the term "pediatric" in the specialty field, or if both variables reported any of the following: "general/family practice," "family medicine," or "general practice." We considered the top 15 states with the greatest number of NCQA-recognized child-serving providers as candidate states for these analyses. To help reduce the number of states for the feasibility analysis, we also assessed the penetration of CMC among Medicaid enrollees. Because beneficiaries enrolled in CMC may not have their complete claims data included in the Medicaid Statistical Information System (MSIS) and MAX files, our feasibility analysis and the full study will include only FFS enrollees.

Appendix Table A.1 lists the states in order by the number of NCQA-recognized providers. The top 15 states included New York, Pennsylvania, North Carolina, Texas, Wisconsin, Washington, Colorado, Michigan, Maine, Connecticut, New Hampshire, Ohio, Massachusetts, Rhode Island, and Louisiana. We initially excluded New York, Pennsylvania, Washington, Ohio, Michigan, Connecticut, Massachusetts and Rhode Island from consideration because too many children were enrolled in CMC. We excluded North Carolina, as we learned the servicing provider ID field on Medicaid claims data did not identify all services provided by individual providers and we would not be able to identify most NCQA-recognized providers in the data. We also excluded states that did not have 2010 MAX data available, including Wisconsin, Colorado, New Hampshire, Maine, Massachusetts, Rhode Island, and Michigan.

TABLE A.1. Number of Child-Serving Providers and Practices in All States
    Child-Serving  
Providers (N)
  Child-Serving  
Practices (N)
Comprehensive Managed Care
Programs in Candidate States
Reason for Exclusion
from Study
Candidate States: Top 15 States with NCQA-Certified Providers
New York 1,711 513 Approximately 60% of disabled children and 86% of non-disabled children in managed carea High penetration of managed care
Pennsylvania 733 202 Approximately 70% of disabled and non-disabled children in managed carea High penetration of managed care
North Carolina 588 148 No children enrolled in managed carea Data problems with Medicaid servicing provider ID
Texas 431 110 Approximately 50% non-disabled children in CMCa  
Wisconsin 422 113 Approximately 54% all Medicaid beneficiaries (children and adults) in CMCb 2010 MAX data unavailable
Washington 368 44 Approximately 87% of non-disabled children in managed carea High penetration of managed care
Colorado 330 51 Approximately 9% of disabled children, 13% of non-disabled, and 5% of foster care children in managed carea 2010 MAX data unavailable
Michigan 300 99 Approximately 68% of Medicaid beneficiaries enrolled in CMCb High penetration of managed care and 2010 MAX data unavailable
Maine 239 72 No children enrolled in CMCa 2010 MAX data unavailable
Connecticut 233 71 Approximately 58% of all Medicaid beneficiaries (children and adults) inCMCb High penetration of managed care
New Hampshire 206 40 No children enrolled in CMCa  
Ohio 188 52 Approximately 86% of all Medicaid beneficiaries (children and adults) in CMCb High penetration of managed care
Massachusetts 159 29 Approximately 64% of all Medicaid beneficiaries (children and adults) in CMCb High penetration of managed care and 2010 MAX data unavailable
Rhode Island 143 34 Approximately 70% of disabled children and 87% of non-disabled children in CMCa High penetration of managed care and 2010 MAX data unavailable
Louisiana 132 48 No children enrolled in CMCa  
Non-Candidate States (Too Few NCQA-Certified Providers and Practices)
Vermont 129 37 N/R  
Virginia 128 28 N/R  
California 110 16 N/R  
Minnesota 107 21 N/R  
Missouri 107 25 N/R  
South Carolina 106 26 N/R  
New Jersey 105 36 N/R  
Arizona 104 32 N/R  
Tennessee 104 39 N/R  
Hawaii 100 22 N/R  
Florida 88 50 N/R  
New Mexico 75 13 N/R  
Maryland 69 19 N/R  
West Virginia 56 20 N/R  
Illinois 51 17 N/R  
Arkansas 44 2 N/R  
Nevada 42 11 N/R  
District of Columbia 36 7 N/R  
Alabama 34 10 N/R  
Oregon 27 6 N/R  
Montana 26 4 N/R  
Georgia 23 1 N/R  
Indiana 21 6 N/R  
Nebraska 13 4 N/R  
Kansas 10 3 N/R  
Iowa 10 2 N/R  
Arkansas 9 2 N/R  
Delaware 7 2 N/R  
Kentucky 4 2 N/R  
Mississippi 4 1 N/R  
Idaho 2 1 N/R  
NOTES:
  1. Mathematica Policy Research Analysis of MSIS data (most recent quarterly eligibility file).
  2. Kaiser Family Foundation State Health Facts. Available at http://www.statehealthfacts.org/comparemaptable.jsp?ind=985&cat=4. Accessed June 18, 2012.

N/R = Not Reported.

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