Medicaid Analytic Extract Provider Characteristics (MAXPC) Evaluation Report, 2010.

摘要

The Medicaid Statistical Information System (MSIS) files, and the corresponding researcher-friendly Medicaid Analytic eXtract (MAX) data files, support a wide range of studies on Medicaid enrollment, service use, and expenditures. There is currently considerable interest at the Centers for Medicare & Medicaid Services (CMS) in examining health reform proposals, program integrity, and access-to-care issues among Medicaid providers by type of provider. However, it has not been possible to conduct provider-based research activities because the provider identification (ID) numbers collected in MSIS were largely unedited, undocumented, and state-specific. Beginning in 2004, the Health Insurance Portability and Accountability Act (HIPAA) mandated covered entities such as health care providers, health plans, and health care clearinghouses to obtain and use a National Provider Identifier (NPI) in all administrative and financial HIPAA transactions (CMS 2010). The NPI is a unique, 10-digit, sequentially assigned, national identification number, unstructured so as not to carry in any way information such as the state or medical specialty of the health care provider who owns the identifier. Starting in February 2009, CMS required states to include NPIs on their MSIS claims. The main limitation of NPIs is that certain classes of non-medical providers are not required to obtain NPIs. For example, the NPI requirement excludes adult day care, case management, personal care, non-emergency transportation, and many other services. Given that these so-called wrap-around (e.g., non-medical) services can represent a significant part of Medicaids package of services and are of particular interest to policymakers, their exclusion in the assignment of NPIs can be problematic for provider-related research. Nonetheless, the availability of the NPI on MSIS and MAX claims now makes it feasible to develop a uniform provider characteristics data set. Consequently, CMS contracted with Mathematica Policy Research to design and implement the Medicaid Analytic eXtract Provider Characteristics (MAXPC) file.