J-9_Attachment_D_-_MMLEADS_Documentation.pdf

Attachment D

MMLEADS File Information

MMCO has developed the following products to aid researchers in studying the Medicare- Medicaid dually enrolled population. This section is divided into two sections

I. Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS): Summary level data of Medicare & Medicaid expenditures and utilization and beneficiary characteristics (demographics, enrollment and eligibility, and all 27 CCW condition flags (including the 27 CCW conditions and all conditions developed by MMCO across three different rounds (see below)) for Medicare-Medicaid dual enrollees, Medicare-only enrollees, and Medicaid-only beneficiaries with disability (Calendar Years 2006-2009).

II. Medicare-Medicaid Linked Enrollee Analytic Data Source – Version 2 (MMLEADS-v2): Reproduction of MMLEADS (first version, above), for Calendar Years 2006-2009 (2010 is pending), with the following additions:

1. Beneficiary level files unique at the beneficiary level

2. Inclusion of SSA data

● Disability Insurance Benefit Entitlement Date Justification Code

● SSA Disability Insurance Benefit Diagnosis Primary Impairment Code

● SSA Disability Insurance Benefit Diagnosis Secondary Impairment Code

● SSA Disability Insurance Benefit Diagnosis Award Code

● Add VA status

3. De-duplicated services linked at the claim level to allow for unique utilization counts

4. De-duplicated Medicare Part B Rx claims from MAX Rx claims

5. Make service levels comparable between Medicare and Medicaid

6. Inclusion of Medicare capitated payments

7. Add SNP information

8. Add annual and monthly bene-level summaries of all spending expenditures

9. Add Part D contract ID and plan ID

10. Add monthly HMO indicators

11. Separate FQHC from Rural Health for Medicare

12. Inclusion of HIV/AIDS flags

13. Inclusion of substance abuse flags

14. Inclusion of Round 3 Conditions

15. Inclusion of two separate medication classification systems in service file (VA system

(for all users) and FDB (CMS only)

16. Inclusion of two mental/behavioral health service utilization indicators (community-based & residential)

III. Condition Flags: Added to the existing 27 chronic condition indicators on Medicare beneficiaries in the following ways for years 2000-2009 (2010 is pending):

1. Extended the existing 27 CCW flags to include all Medicaid beneficiary data;

2. Created a new dual-eligible specific flag for all existing 27 CCW flags (by having the algorithm glean from both Medicare and Medicaid claims);

3. Create ever-flags for all conditions developed under Rounds 1, 2 and 3

4. For all Medicare, Medicaid and Medicare-Medicaid dually enrolled beneficiary data, developed new flags specific to the study of dual eligible beneficiaries (for years 2000-2009 (2010 is pending), and for Medicare-only 2000-2012), for the following three rounds of flag development:

Round 1: Mental Health and Tobacco-related disorders

1. Attention deficit hyperactivity disorder, conduct and impulse disorders

2. Anxiety disorders

3. Bipolar disorder

4. Type 1 major depression and type 2 depressive disorders

5. Personality disorders

6. Post-traumatic stress disorders

7. Schizophrenia

8. Schizophrenia and other psychotic disorders

9. Tobacco-related conditions

Second Round: Conditions often associated with disability

1. Autism Spectrum Disorders

2. Cerebral Palsy

3. Cystic Fibrosis and Other Metabolic Developmental Disorders

4. Epilepsy

5. Intellectual Disabilities and Related Conditions

6. Learning Disabilities

7. Mobility Impairments

8. Multiple Sclerosis and Transverse Myelitis

9. Muscular Dystrophy

10. Other Developmental Delays

11. Sensory - Deafness and Hearing Impairment

12. Sensory - Blindness and Visual Impairment

13. Spina Bifida and Other Congenital Anomalies of the Nervous System

14. Spinal Cord Injury

15. Traumatic Brain Injury and Nonpsychotic Mental Disorders due to Brain

Damage

Third Round: Pain/Quality of Life Conditions, Potentially Preventable Conditions, and HIV/AIDS Assisting Flags

3A. Pain/Quality of Life-related:

1. Fibromyalgia, Chronic Pain and Chronic Fatigue

2. Migraine and other chronic Headache

3. Leukemia and Lymphoma

3B. Potentially Preventable:

4. Alcohol Use Disorders (for CMS internal use only, until SAMHSA approves the release of this flag to non-CMS researchers)

5. Drug Use Disorders (for CMS internal use only, until SAMHSA approves the release of this flag to non-CMS researchers)

6. HIV/AIDS flags: (1+ inpatient claim or 2+ non-inpatient claims of any claim-type required to qualify over 2 calendar years) (7 flags)

7. Liver disease, cirrhosis, and other liver conditions

8. Obesity (BMI>25)

9. Viral Hepatitis (B & C)

10. Peripheral vascular disease

11. Pressure ulcers and chronic ulcers

3C. HIV/AIDS Assisting Flags:

12. Medicare/Medicaid Testing for HIV (number of unique days with one or more HIV/AIDS screening test: { 0,1,2,3,4,5,6,7,8,9+})

13. Antiretroviral medication use (number of unique days with one or more ARV medications filled: { 0,1,2,3,4,5,6,7,8,9+})

14. HIV/AIDS Health Care Services Contact (1+ claim of any claim-type required to qualify over 1 calendar year)

15. HIV/AIDS program participation – (demonstration, waiver, health home, etc)

16. SSA Disability-Qualifying Primary Diagnosis– (Asymptomatic HIV, Symptomatic HIV, HIV/AIDS Wasting Syndrome, HIV/AIDS Encephalopathy)

17. SSA Disability-Qualifying Secondary Diagnosis – (Asymptomatic HIV, Symptomatic HIV, HIV/AIDS Wasting Syndrome, HIV/AIDS Encephalopathy)