Recommendations for Monitoring Access to Care among Medicaid Beneficiaries at the State-level. Realized Access from MSIS

02/01/2013

Indicator: Percent of state population who are eligible beneficiaries

Description/Purpose: To identify proportion of population eligible for services.

Data sources: ELIGIBLE (numerator), To be derived from an Extant source such as the American Community Survey of the Current Population Survey (denominator)

Time period: Monthly/quarterly/annually

Universe: All state residents.

Numerator: All eligible beneficiaries with at least 1 month FFS eligibility during <time period>.

Denominator: State population count for <time period>.

Type: Continuous

Values/labels: 0 - 100%

Potential recodes: Categories

Stratification: Race, ethnicity, age, sex, basis of eligibility category, TANF, dual-eligible

 

Indicator: Percent of eligible beneficiaries that are beneficiaries served

Description/Purpose: To identify proportion of eligible beneficiaries that use services.

Data sources: CLAIMSXX (numerator), ELIGIBLE (denominator)

Time period: Monthly/quarterly/annually

Universe: All state residents.

Numerator: Sum of eligible beneficiaries with at least 1 month FFS eligibility AND one claim during <time period>.

Denominator: All eligible beneficiaries with at least 1 month FFS eligibility during <time period>.

Type: Continuous

Values/labels: 0 - 100%

Potential recodes: Categories

Stratification: Race, ethnicity, age, sex, basis of eligibility category, TANF, dual-eligible

 

Indicator: Percent of Eligible Beneficiaries with at least one Ambulatory Care Visit

Description/Purpose: Indicator of regular/usual treatment among target population.

Data sources: CLAIMOT (numerator), ELIGIBLE (denominator)

Time period: Monthly/quarterly/annually

Universe: All eligible beneficiaries with at least 3 months FFS eligibility during <time period>.

Numerator: Sum of ambulatory care visits (TYPE-OF-VISIT = <select>) for eligible beneficiaries with at least 3 months FFS eligibility during <time period>.

Denominator: All eligible beneficiaries with at least 3 months FFS eligibility during <time period>.

Type: Continuous

Values/labels: 0 - 100%

Potential recodes: Categories

Stratification: Race, ethnicity, age, sex, basis of eligibility category, TANF, dual-eligible

Notes: Number of visits based on claims for a unique beneficiary, provider ID and single service day. May need to combine with SPECIALTY-CODE, coding varies by state.

 

Indicator: Percent of Eligible Beneficiaries with at least one Specialty Care (Aggregate) Visit

Description/Purpose: Indicator of regular/usual treatment among target population.

Data sources: CLAIMOT (numerator), ELIGIBLE (denominator)

Time period: Monthly/quarterly/annually

Universe: All eligible beneficiaries with at least 1 month FFS eligibility during <time period>.

Numerator: Sum of all specialty care visits (SPECIALTY-CODE=<select codes>) for eligible beneficiaries with at least 1 month FFS eligibility during <time period>.

Denominator: All eligible beneficiaries with at least 1 month FFS eligibility during <time period>.

Type: Continuous

Values/labels: 0 - 100%

Potential recodes: Categories

Stratification: Race, ethnicity, age, sex, basis of eligibility category, TANF, dual-eligible

Notes: No standard coding for this field, state-specific.

 

Indicator: Percent of Eligible Beneficiaries with at least one Specialty Care (Specific) Visit

Description/Purpose: Indicator of regular/usual treatment among target population.

Data sources: CLAIMOT (numerator), ELIGIBLE (denominator)

Time period: Monthly/quarterly/annually

Universe: All eligible beneficiaries with at least 1 month FFS eligibility during <time period>.

Numerator: Sum of specialty care visits (SPECIALTY-CODE=<specialty of interest>) for eligible beneficiaries with at least 1 month FFS eligibility during <time period>.

Denominator: All eligible beneficiaries with at least 1 month FFS eligibility during <time period>.

Type: Continuous

Values/labels: 0 - 100%

Potential recodes: Categories

Stratification: Race, ethnicity, age, sex, basis of eligibility category, TANF, dual-eligible

Notes: No standard coding for this field, state-specific. This variable can be repeated for all specialty codes of interest.

 

Indicator: Number of Unique Beneficiaries Served Per Provider

Description/Purpose: Indicates level of beneficiaries served by provider.

Data sources: ELIGIBLE, CLAIMSXX (numerator), CLAIMSOT (denominator)

Time period: Monthly/quarterly/annually

Universe: Sum of unique beneficiaries with at least 1 month FFS eligibility AND one claim during <time period>.

Numerator: Sum of unique beneficiaries with at least 1 month FFS eligibility AND one claim during <time period>.

Denominator: Sum of unique providers with at least one (SERVICE CODE) during <time period>.

Type: Continuous

Values/labels: 0 - 100%

Potential recodes: Categories

Stratification: Race, ethnicity, age, sex, basis of eligibility category, TANF, dual-eligible

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