Community-based LT care (CLTC) flag

SAS Name
CLTC_FLAG

CODE INDICATING THE MAX TYPE OF SERVICE AND/OR PROGRAM TYPE THAT CAN QUALIFY THE FEE-FOR-SERVICE CLAIM AS A POTENTIAL COMMUNITY-BASED LONG-TERM CARE SERVICE CLAIM. WAIVER SERVICES INCLUDE SERVICES COVERED UNDER 1915(C) WAIVERS THAT ARE IDENTIFIED IN 'MSIS TYPE OF PROGRAM CODE' = 6 OR 7.

Comments

USER NOTE: BECAUSE THERE IS AMBIGUITY REGARDING WHAT SERVICES ARE FOR COMMUNITY-BASED LONG-TERM CARE (CLTC), A BROAD SET OF CLAIMS IS IDENTIFIED IN THE CLTC INDICATOR. RESEARCHERS SHOULD USE CAUTION WHEN DETERMINING WHICH CODES TO UTILIZE IN CLTC ANALYSES.
NOTE: IN MAX 2005, THIS VARIABLE WAS ADDED TO THE FILE.

SOURCE: CODED IN THE MAX DEVELOPMENT PROCESS.

Code Code value
00 NOT A CLTC CLAIM
11 NON-WAIVER PERSONAL CARE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 30
12 NON-WAIVER PRIVATE DUTY NURSING PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 38
13 NON-WAIVER ADULT DAY PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 54
14 NON-WAIVER HOME HEALTH PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 13
15 NON-WAIVER RESIDENTIAL CARE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 52
16 NON-WAIVER REHABILITATION FOR AGED OR DISABLED ENROLLEE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 33 AND BOE EQ (1 OR 2)
17 NON-WAIVER TARGETED CASE MANAGEMENT FOR AGED OR DISABLED ENROLLEE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 31 AND BOE EQ (1 OR 2)
18 NON-WAIVER TRANSPORTATION FOR AGED OR DISABLED ENROLLEE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 26 AND BOE EQ (1 OR 2)
19 NON-WAIVER HOSPICE CARE FOR AGED OR DISABLED ENROLLEE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 35 AND BOE EQ (1 OR 2)
20 NON-WAIVER DURABLE MEDICAL EQUIPMENT FOR AGED OR DISABLED ENROLLEE PROGRAM TYPE NE (6 OR 7) AND MAX TOS = 51 AND BOE EQ (1 OR 2)
30 WAIVER SERVICE IN ANY OTHER TYPE OF SERVICE NOT LISTED BELOW PROGRAM TYPE EQ (6 OR 7) AND MAX TOS NE (30, 38, 54, 13, 52, 33, 31, 26, 35, 51)
31 WAIVER PERSONAL CARE PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 30
32 WAIVER PRIVATE DUTY NURSING PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 38
33 WAIVER ADULT DAY PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 54
34 WAIVER HOME HEALTH PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 13
35 WAIVER RESIDENTIAL CARE PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 52
36 WAIVER REHABILITATION PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 33
37 WAIVER TARGETED CASE MANAGEMENT PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 31
38 WAIVER TRANSPORTATION PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 26
39 WAIVER HOSPICE CARE PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 35
40 WAIVER DURABLE MEDICAL EQUIPMENT PROGRAM TYPE EQ (6 OR 7) AND MAX TOS = 51