Medicaid-Financed Institutional Services: Characteristics of Nursing Home and ICF/IID Residents and Their Patterns of Care. Appendix C. State Nursing Home and ICF/IID Anomalies

08/01/2013

The MAX data contain a variety of anomalies, many of which are specific to individual states. The anomalies most likely to affect analyses of nursing home or ICF/IID care are listed below, by state. A full list of anomalies is available from the CMS website at https://www.cms.gov/MedicaidDataSourcesGenInfo/07_MAXGeneralInformation.asp. Unless otherwise indicated, all anomalies and notes below relate to 2007 MAX data.

As a result of these anomalies, six states were excluded from all analyses: Indiana, Maine, and Utah, because complete 2007 data were not available for these states; Arizona, because it provides most long-term services via managed care arrangements, whereas this study analyzes services provided on a FFS basis; Minnesota, because the state was transitioning many of its enrollees using long-term care to managed care during the study period; and New Hampshire, because its expenditure data for HCBS relative to institutional long-term care varied substantially from corresponding CMS Form 64 data in 2007.

Analyses of the association between median length-of-stay and state policy variables omitted seven other states because the quality of their HCBS data was believed to be unreliable: Massachusetts, Michigan, Montana, Oregon, Pennsylvania, Rhode Island, and Texas.

  • All States. (1) Service tracking claims: expenditures reported as service tracking claims are not included in MAX as they cannot be attributed to specific persons for specific services. (2) Day count: the states use a variety of time periods for billing long-term care services ranging from weekly to monthly and sometimes reflecting the actual time period with covered days. This means that the number of covered days per claim varies between and within states.

  • Alabama. No relevant anomalies or notes.

  • Alaska. (1) The average Medicaid payment amount for nursing facility claims is about two times higher than the national average, but is consistent across years. (2) Relatively few Medicaid enrollees have nursing facility claims because Alaska has a small elderly population and active HCBS waiver program. It also has a state-operated Pioneers Home System, not included in Medicaid, which provides services for many people who otherwise might be covered by Medicaid.

  • Arizona. Most people are enrolled in managed care and more than half the other Medicaid enrollees are in the Indian Health Service, so FFS distributions are unusual; the state was excluded for this reason.

  • Arkansas. No relevant anomalies or notes.

  • California. No relevant anomalies or notes.

  • Colorado. There was a large increase in FFS crossover claims in 2007.

  • Connecticut. No relevant anomalies or notes.

  • Delaware. No relevant anomalies or notes.

  • District of Columbia. No relevant anomalies or notes.

  • Florida. Admission date and patient status are missing on most claims.

  • Georgia. (1) Very few claims have leave days in 2006 even though Georgia covers leave days in several circumstances. (2) Institutional care expenditures as reported in the MAX data and on CMS Form 64 differed substantially (a variance of at least 33 percent in 2007).

  • Hawaii. The percentage of claims reporting leave days is below the expected range.

  • Idaho. No relevant anomalies or notes.

  • Illinois. Patient status is missing on all claims.

  • Indiana. The Indiana MAX file for 2007 was not complete as of the time of this writing; the state was excluded for this reason.

  • Iowa. No relevant anomalies or notes.

  • Kansas. If the state does not pay for all the covered days submitted by the provider on a claim, the covered days field is not corrected, only the payment amount.

  • Kentucky. No relevant anomalies or notes.

  • Louisiana. The admission date is missing on most records in 2006.

  • Maine. Maine has been unable to accurately report its inpatient, long-term care, or other claims as it does not have a functioning Medicaid Management Information System; the state was excluded for this reason.

  • Maryland. Maryland does not report leave days even though it covers leave days under some circumstances.

  • Massachusetts. (1) There was an increase of approximately 80 percent in the total number of crossover claims from 2006. (2) No leave days are reported although Massachusetts covers up to 35 leave days per year. (3) Massachusetts' HCBS data were believed to be unreliable (see Wenzlow et al. 2011 for details); the state was excluded from analyses of state policy variables for this reason.

  • Michigan. Michigan's HCBS data were believed to be unreliable (see Wenzlow et al. 2011 for details); the state was excluded from analyses of state policy variables for this reason.

  • Minnesota. (1) The ICF/IID covered days are missing on many ICF/IID claims in 2006. (2) Minnesota was transitioning many of its enrollees using long-term care to managed care during the 2006-2007 period; the state was excluded for this reason.

  • Mississippi. No relevant anomalies or notes.

  • Missouri. The admission date is not reported.

  • Montana. (1) Patient status is not available on most claims. (2) Montana's HCBS data were believed to be unreliable (see Wenzlow et al. 2011 for details); the state was excluded from analyses of state policy variables for this reason.

  • Nebraska. No relevant anomalies or notes.

  • Nevada. There were only a few claims with leave days reported in 2006 even though Nevada covers up to 24 leave days per year.

  • New Hampshire. (1) Many 2006 claims could not be properly adjusted because of how adjustment claims were submitted to MSIS. There are likely to be duplicates because only the original and replacement claims were reported and the voids were not included. Days are repeated on every claim, overstating covered days. (2) New Hampshire's expenditure data for HCBS relative to institutional long-term care varied substantially from corresponding CMS Form 64 data in 2007; the state was excluded for this reason.

  • New Jersey. No relevant anomalies or notes.

  • New Mexico. No relevant anomalies or notes.

  • New York. The admission date is missing on most claims.

  • North Carolina. No relevant anomalies or notes.

  • North Dakota. No relevant anomalies or notes.

  • Ohio. The admission date and patient status are missing on most claims.

  • Oklahoma. No relevant anomalies or notes.

  • Oregon. (1) The admission date is not reported. (2) Oregon's HCBS data were believed to be unreliable (see Wenzlow et al. 2011 for details); the state was excluded from analyses of state policy variables for this reason.

  • Pennsylvania. Pennsylvania's HCBS data were believed to be unreliable (see Wenzlow et al. 2011 for details); the state was excluded from analyses of state policy variables for this reason.

  • Rhode Island. (1) Rhode Island does not specify coverage of leave days in its state plan and no leave days are reported. (2) Institutional care expenditures as reported in the MAX data and on CMS Form 64 differed substantially (a variance of at least 33 percent in 2007). (3) Rhode Island's HCBS data were believed to be unreliable (see Wenzlow et al. 2011 for details); the state was excluded from analyses of state policy variables for this reason.

  • South Carolina. (1) The admission date and patient status are missing on most claims. (2) South Carolina does not report leave days on claims, although it covers leave days in many situations.

  • South Dakota. No relevant anomalies or notes.

  • Tennessee. Institutional care expenditures as reported in the MAX data and on CMS Form 64 differed substantially (a variance of at least 33 percent in 2007).

  • Texas. (1) The admission date and patient status are missing on most claims. (2) Leave days: leave days are not reported. (3) Texas' HCBS data were believed to be unreliable (see Wenzlow et al. 2011 for details); the state was excluded from analyses of state policy variables for this reason.

  • Utah. (1) The Utah MAX file for 2007 was not created as of the time of this writing because the state had not submitted acceptable eligibility files; the state was excluded for this reason. (2) The admission date and patient status are missing on most institutional claims in 2006.

  • Vermont. Very few leave days are reported.

  • Virginia. No relevant anomalies or notes.

  • Washington. No relevant anomalies or notes.

  • West Virginia. No relevant anomalies or notes.

  • Wisconsin. No relevant anomalies or notes.

  • Wyoming. No relevant anomalies or notes.

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