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Technical Assistance to States for Managed Care Encounter Data

Description

Task X of the Medicaid Analytic eXtract Production, Enhancement, and Data Quality (MAX-PDQ) contract was designed to improve the quality and completeness of encounter data reporting into the Medicaid Statistical Information System (MSIS) by providing technical assistance (TA) to state Medicaid agencies.  For some states, the need for encounter data assistance occurs before the point at which they are ready to begin submitting encounter data through MSIS. They need help in working with Managed Care Organizations to obtain the encounter data that the state then reports to CMS. The first report released under this task, titled "Collecting, Using, and Reporting Medicaid Encounter Data: A Primer for States" is a primer aimed at helping states that are in this earlier state of collecting, using, and reporting encounter data. It also provides some basic guidance regarding the submission of encounter data into MSIS.

Reports and Issue Briefs

  • “Assessing the Usability of Encounter Data for Enrollees in Comprehensive Managed Care Across MAX 2007–2009”. This issue brief assesses the availability, completeness, and quality of encounter data in MAX 2007–2009. The analysis builds on our previous reviews of MAX 2007 and 2008 encounter data by evaluating MAX 2009 physician, outpatient, and clinic services (OT), inpatient hospital services (IP), and prescription drug services (RX), and by assessing trends in the availability and usability of encounter data across the three year period. The analysis provides tools to assist researchers and policymakers in determining which states’ encounter data to analyze. The increase in reporting and usability makes the inclusion of encounter data in research studies a more viable option than in the past. This issue brief is available through the links in the “Downloads” section.
  • “The Availability and Usability of Behavioral Health Organization (BHO) Encounter Data in MAX 2009”. The purpose of this issue brief is to provide a detailed analysis of the behavioral health organization (BHO) encounter data in MAX 2009 and assess the viability of using these data for research and policy analysis. This issue brief is available through the links in the “Downloads” section.
  • “Assessing the Usability of MAX 2008 Encounter Data for Enrollees in Comprehensive Managed Care.” This issue brief provides an assessment of the selected other services (OT), inpatient (IP), and prescription drug (RX) encounter data for enrollees in comprehensive managed care during 2008. This issue brief summarizes the availability, completeness, quality and usability of the encounter data for comprehensive managed care enrollees by basis of eligibility (BOE) category as well as gives specific information by state. It also examines the changes in the IP and RX encounter data from 2007 to 2008. The results are encouraging for researchers and policymakers. Most states that have comprehensive managed care plans are reporting IP, RX, and OT encounter data. Of those data, the majority are usable. The number of states submitting usable encounter data is increasing. Please see the “Downloads” section below.
  • “Assessing the Usability of the MAX 2007 Inpatient Hospital (IP) and Prescription Drug (RX) Encounter Data for Enrollees in Comprehensive Managed Care”. As growing numbers of Medicaid enrollees receive health benefits through comprehensive managed care, the researchers and policymakers seeking to understand the service use of these enrollees must rely on encounter data that states receive from managed care plans. Although encounter data provide insight into the service use of comprehensive managed care enrollees, not all states report encounter data, and little is known about the data’s usability. This issue brief summarizes the availability, completeness, quality and usability of the MAX encounter data for comprehensive managed care enrollees in 2007 by basis of eligibility (BOE) category as well as gives specific information by state. The results are encouraging. Most states that have comprehensive managed care plans are reporting IP and RX encounter data. Of those data, the majority are usable. It is available through links in the “Downloads” section below.
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