MAX and Beta-MAX Design Report and Work Plan.

摘要

Beginning in 1999, all states and the District of Columbia were required to report Medicaid enrollee eligibility and claims data in a standard format into the Medicaid Statistical Information System (MSIS). Mathematica Policy Research, on behalf of the Centers for Medicare & Medicaid Services (CMS), has produced research files derived from these data for each state, by calendar year; the research files are known as the Medicaid Analytic eXtract (MAX) files. As the quality of the Medicaid data submitted by the states has improved over the years, the MAX files have become one of the most important research tools for measuring Medicaid enrollment and understanding patterns of Medicaid service use and expenditures across states and over time. There are six MAX files derived from the MSIS data. The Person Summary (PS) file contains one record for each person who is enrolled in either Medicaid or the Childrens Health Insurance Program (CHIP) in the MAX calendar year. It contains information about eligibility, demographics, summary expenditures, and service use. The inpatient hospital (IP) file contains claims for inpatient hospital services. The long-term care (LT) file contains claims for long-term care received in institutions such as nursing facilities, intermediate care facilities for the mentally retarded, and psychiatric hospitals. The other services (OT) file contains claims for services provided in the community, in hospitals, and in long-term care facilities, as well as per-person capitation claims for services provided by managed care organizations. The prescription drug (RX) file contains claims for prescription drugs and durable medical equipment prescribed by a pharmacist.