Search Data Variables

Medicaid payment amount (Unknown)

TOTAL FEE-FOR-SERVICE MEDICAID PAYMENTS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD8)

Medicaid payment amount (Unknown)

TOTAL FEE-FOR-SERVICE MEDICAID PAYMENTS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTED FOR THE FOR ALL TYPES OF SERVICE EXCEPT TOS = 20, 21 AND 22.

(SAS USERS: ZONED DECIMAL - ZD8)

Medicaid Payment Amount — April

This variable is the sum of Medicaid payment amount from the inpatient (IP), long-term care (LT), pharmacy (RX), and other services (OT) (header) claims for the beneficiary for each month. Note that this dollar amount may be an undercount if the beneficiary had managed care claims.

Medicaid Payment Amount — August

Medicaid Payment Amount — December

Medicaid Payment Amount — February

Medicaid Payment Amount — Inpatient

This variable is the total Medicaid payment amount from all Inpatient (IP) claims for the beneficiary during the year. Note that this dollar amount may be an undercount if the beneficiary had managed care claims.

Medicaid Payment Amount — January

Medicaid Payment Amount — July

Medicaid Payment Amount — June

Medicaid Payment Amount — Long-Term Care

This variable is the total Medicaid payment amount from all long-term care (LT) claims for the beneficiary during the year. Note that this dollar amount may be an undercount if the beneficiary had managed care claims.

Medicaid Payment Amount — March

Medicaid Payment Amount — May

Medicaid Payment Amount — Non-Capitated Total

This variable is the sum of Medicaid payment amount from other services (OT) (header) claims for the beneficiary during the year, after removing the Medicaid managed care capitated payments. Note that this dollar amount may be an undercount if the beneficiary had managed care claims.

Medicaid Payment Amount — November

Medicaid Payment Amount — October

Medicaid Payment Amount — Other Services

This variable is the sum of Medicaid payment amount from the other services (OT) (header) claims for the beneficiary during the year, after removing the managed care capitated payments. Note that this dollar amount may be an undercount if the beneficiary had managed care claims.

Medicaid Payment Amount — Rx

This variable is the total Medicaid payment amount from all pharmacy (RX) claims for the beneficiary during the year. Note that this dollar amount may be an undercount if the beneficiary had managed care claims.

Medicaid Payment Amount — September

Medicaid Payment Amount — Total

This variable is the sum of Medicaid payment amount from the inpatient (IP), long-term care (LT), pharmacy (RX) and other services (OT) (header) claims for the beneficiary during the year. Note that this dollar amount may be an undercount if the beneficiary had managed care claims.

Medicaid premium payments (HMO/HIO)

TOTAL DOLLAR AMOUNT OF PREMIUM PAYMENTS THAT WERE MADE TO A CAPITATED (PREPAID) PLAN FOR THIS ELIGIBLE DURING THE CALENDAR YEAR. THIS DATA ELEMENT IS REPORTED ONLY FOR TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD8)

Medicaid premium payments (PCCM)

TOTAL DOLLAR AMOUNT OF PREMIUM PAYMENTS THAT WERE MADE TO A CAPITATED (PREPAID) PLAN FOR THIS ELIGIBLE DURING THE CALENDAR YEAR. THIS DATA ELEMENT IS REPORTED ONLY FOR TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD8)

Medicaid premium payments (PHP)

TOTAL DOLLAR AMOUNT OF PREMIUM PAYMENTS THAT WERE MADE TO A CAPITATED (PREPAID) PLAN FOR THIS ELIGIBLE DURING THE CALENDAR YEAR. THIS DATA ELEMENT IS REPORTED ONLY FOR TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD8)

Medicaid RUG CMI Set Used

This field contains the Medicaid set code that was used in the RUB calculation for this assessment by the state MDS system.

Medicaid RUG Group

This field contains the Medicaid RUG group calculated for this assessment by the state MDS system.

Medicaid RUG Version

This field contains the Medicaid RUG calculator version used for this assessment by the state MDS system.

Medicaid Use (Claim Count) — April

This variable is the total count of Medicaid inpatient (IP), long-term care (LT), pharmacy (RX) and other services (OT) (header) claims for the beneficiary for each month, after removing the managed care capitated payment claims from the OT file.

Medicaid Use (Claim Count) — August

Medicaid Use (Claim Count) — December

Medicaid Use (Claim Count) — February

Medicaid Use (Claim Count) — Inpatient

This variable is the total count of Medicaid Inpatient (IP) (header) claims for the beneficiary during the year.

Medicaid Use (Claim Count) — January

Medicaid Use (Claim Count) — July

Medicaid Use (Claim Count) — June

Medicaid Use (Claim Count) — Long-Term Care

This variable is the total count of Medicaid long-term care (LT) (header) claims for the beneficiary during the year.

Medicaid Use (Claim Count) — March

Medicaid Use (Claim Count) — May

Medicaid Use (Claim Count) — November

Medicaid Use (Claim Count) — October

Medicaid Use (Claim Count) — Other Services

This variable is the total count of Medicaid other services (OT) (header) claims for the beneficiary after removing the managed care capitated payments.

Medicaid Use (Claim Count) — Rx

This variable is the total count of Medicaid Pharmacy (RX) (header) claims for the beneficiary during the year.

Medicaid Use (Claim Count) — September

Medicaid Use (Claim Count) — Total

This variable is the total count of Medicaid inpatient (IP), long-term care (LT), pharmacy (RX), and other services (OT) (header) claims for the beneficiary for during the year, after removing the managed care capitated payment claims from the OT file.

Medicaid — 1115 Waiver Type Code — Latest in Year

This variable is the code to indicate the type of 1115 waiver under which the beneficiary received Medicaid coverage; most recent in the calendar year.

Medicaid — 1915(b) Waiver Months

This variable is the number of months the beneficiary was enrolled in a Medicaid Section 1915(b) waiver during the year.

Medicaid — 1915(b)(c) Waiver Months

This variable is the number of months the beneficiary was enrolled in a Medicaid concurrent (combined) Section 1915(b)(c) waiver during the year.

Medicaid — 1915(c) Waiver Months

This variable is the number of months the beneficiary was enrolled in a Medicaid Section 1915(c) (Home- and Community-Based Care) waiver during the year.

Medicaid — 1915(c) Waiver Type Code — Latest in Year

This variable is the code to indicate the type of 1915(c) waiver under which the beneficiary received Medicaid coverage; most recent in the calendar year.

Medicaid — Comprehensive Managed Care Months

This variable is the number of months during the year the beneficiary was enrolled in a Medicaid Comprehensive Managed Care Organization (MCO) Managed Care Plan.

Medicaid — Custodial Level of Care for LTSS Months

This variable is the number of months during the year where the beneficiary’s Medicaid monthly LongTerm Services and Supports (LTSS) Level of Care Code indicated that custodial care was required to meet a beneficiary's needs.