Studying Recipients of Long-Term Care Services and Supports: A Case Study in Assembling Medicaid and Medicare Claims and Assessment Data in California
(2011, November,). Studying Recipients of Long-Term Care Services and Supports: A Case Study in Assembling Medicaid and Medicare Claims and Assessment Data in California San Francisco: California Medicaid Research Institute, University of California.
Abstract
Executive Summary
A new body of research will be needed to help federal and state policy makers identify methods for improving the quality and efficiency of care for individuals with long-term services and supports (LTSS) needs enrolled in Medicaid only and in both Medicaid and Medicare for dual eligibles. Such research can benefit from Medicaid’s and Medicare’s administrative data to evaluate services provided to individuals by need and along the entire care continuum. To be useful to policy-makers, research must be comprehensive, scientifically valid, and timely.
To date, however, these studies are extremely limited in number and reach. This is in part because researchers face significant challenges in acquiring and assembling the large sets of Medicaid and Medicare program data needed for an analysis of this scale.
At the request of the California Department of Health Care Services (DHCS) and with co-funding from The SCAN Foundation, the California Medicaid Research Institute (CaMRI) is conducting a statewide comprehensive study of Medicaid LTSS in California between calendar years (CYs) 2005-2008. To do this, CaMRI is developing an integrated and longitudinal database containing claims and assessment data from both Medi-Cal (California’s Medicaid program) and Medicare. This database will be used to describe LTSS users in California and their characteristics, including demographics, medical conditions, disabilities, costs and patterns of service use across both Medi-Cal and Medicare. This study will assist DHCS and the Centers for Medicare and Medicaid Services (CMS) in better understanding how to deliver care for this population more effectively and efficiently.
This report describes the process CaMRI underwent with its state and federal partners to acquire these data for analysis. Specifically, it contains a timeline of the various activities involved in requesting Medi-Cal data from the state and Medicare data from CMS. This report then describes the contracts and data use agreements that allowed for the sharing of Medi-Cal and Medicare data, as well as some of the methods CaMRI underwent to comply with these agreements. Examples of some of the complexities CaMRI faced in linking and cleaning these different data files are also provided. Further, this report includes a discussion of some of the major issues, challenges, and obstacles CaMRI has faced to date, including the complexity of acquiring assessment data from multiple departments with the Agency, the discrepancies in the delivery of the data that were delivered, and the significant role the state Medicaid department played in facilitating this study, among other things. The authors of this report believe the following recommendations, if implemented, can better facilitate additional research of this kind.
- CMS should establish more efficient, timely and routine approaches to share accurate, complete and current federal claims and assessment data with state Medicaid programs.
- CMS can play a leadership role in standardizing the definitions of certain demographic and other variables across and within federal and state data sets; establish additional procedures for auditing and editing data to enhance their accuracy; and create and disseminate tools for the assembly and analysis of Medicaid and Medicare data.
- To attract research partners, state Medicaid programs need to minimize financial and administrative barriers to delivering data to researchers in a timely fashion,
- States should establish interagency agreements to support the sharing of data across departments to operate and evaluate LTSS and other services.
- To monitor the performance of Medicaid managed care programs, Medicaid agencies should require plans to routinely submit accurate and complete information on all encounters.
- Agencies that make assessments of Medicaid beneficiaries to determine eligibility for LTSS should establish a standardized, electronic minimum data set so comparable assessments can be made of beneficiaries' functional and cognitive status over time, regardless of care setting.
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