Evidence-Based Practices for Medicaid Beneficiaries with Schizophrenia and Bipolar Disorder. B. State Selection Process

04/09/2012

We examined three types of records to determine whether each state’s MAX data were sufficiently complete and reliable to identify beneficiaries with schizophrenia and bipolar disorder and to measure such beneficiaries’ use of Medicaid-funded services. First, we examined the enrollment records in the person summary file to ensure that the coding of key variables used to include or exclude certain populations was reliable. Second, we examined the FFS claims records in the IP, other acute care medical (OT), and RX files to ensure that no data reporting or data quality issues would cause omitted claims or key variables to be incompletely coded. Last, in states that enroll nondual disabled beneficiaries into risk-based managed care plans that cover some of the EBPs measured in this study,13 we examined the IP, OT, and RX files to ensure that each managed care plan reported encounter data and that the diagnosis coding was complete on the encounter records. As a final check, we compared across states the proportion of nondual disabled adults who had a diagnosis of schizophrenia or bipolar disorder to check for outlier values. Table A.2 summarizes the results of the state selection process and identify the states for inclusion in the analysis.

TABLE A.2. Summary of State Selection Process

Completeness and Reliability of MAX 2007 Data

States

States Included in or Excluded from the Study

Problem with Enrollment File
Problems with reliably identifying beneficiaries enrolled in managed care, waiver programs, or with private insurance coverage Arkansas, Kansas, Montana, South Carolina, Utah (5 states) Excluded from analysis
Problem with FFS Claims in IP, OT, or RX Files
Missing FFS claims or FFS claims with incomplete coding on key analysis variables Hawaii, Maine, Rhode Island, Texas, Washington (5 states) Excluded from analysis
Abnormally low percentage of disabled beneficiaries had claims with schizophrenia or bipolar disorder diagnoses, indicating missing mental health data Vermont (1 state) Excluded from analysis
Problem with Encounter Claims in IP, OT, or RX Files
Significant enrollment of nondual disabled in managed care, but no encounter data reported Colorado, Florida, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania (7 states) Excluded from analysis
Significant enrollment of nondual disabled in managed care, but plan identifiers do not match between enrollment and claims files Kentucky, Oregon, Tennessee, Virginia, Wisconsin (5 states) Excluded from analysis
Significant enrollment of nondual disabled in managed care, with problems discovered in completeness of encounter data Arizona, Delaware, Minnesota, New Jersey, New Mexico, New York (6 states) Excluded from analysis
No Major Data Problems Identified
Very low enrollment of nondual disabled into HMOs or BHOs with no encounter data reported, and no major problems with FFS data District of Columbia, Missouri, North Carolina, West Virginia (4 states) Only FFS enrollees included in analysis
Significant enrollment of nondual disabled into HMOs, BHOs, or other managed care, with no major encounter data problems detected Alabama, California, Indiana, Iowa, Maryland, Oklahoma (6 states) All beneficiaries included in analysis
No enrollment of nondual disabled into HMOs or BHOs, and no major problems with FFS data Alaska, Connecticut, Georgia, Idaho, Illinois, Louisiana, Mississippi, Nevada, New Hampshire, North Dakota, South Dakota, Wyoming (12 states) All beneficiaries included in analysis

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