Category: MAOTD (Medicaid Acronym of the Day)

State Health Access Data Assistance Center –

SHADAC is a multidisciplinary health policy research center with a focus on state policy. Our staff members represent a broad range of expertise, ranging from economics, statistics and evaluation to sociology and journalism. We are passionate about the importance of using sound data to inform policy decisions, and work collaboratively with our clients to achieve results. SHADAC strives to produce rigorous, policy-driven analyses. We translate complex findings into actionable information that is accessible to a broad audience. Thanks to our long history of working with state agencies and foundations, we’ve developed a deep understanding of the unique challenges and opportunities states face.

We specialize in:

State and federal health policy and health reform
Health insurance exchanges
Payment and delivery system reform
Medicaid
Health systems
Barriers to coverage and access
Population health

Further reading –

http://www.shadac.org/

T-MSIS, which stands for Transformed Medicaid Statistical Information System, is an expansion of the existing Centers for Medicare & Medicaid (CMS) MSIS extract process. T-MSIS is mandated by CMS and the Affordable Care Act (ACA), and is a natural extension of current Decision Support Systems (DSS) and data warehouse solutions in state agencies today.

As part of the CMS plan to improve and expand upon its Medicaid data repository, states are required to augment the current MSIS data extracts. Currently, each state submits five MSIS extracts to CMS on a quarterly basis. These data are used by CMS to assist in federal reporting for the Medicaid and Children’s Health Insurance Program (CHIP). Several reasons culminated in the CMS mission to improve the repository, including incomplete data, questionable results, multiple data collections from states, multiple federal data platforms, and analytic difficulties in interpreting and presenting the results. In addition, timeliness issues have prompted CMS to re-evaluate its processes and move toward a streamlined delivery, along with an enhanced data repository.

The new T-MSIS extract format and frequency is expected to further CMS goals for improved timeliness, reliability, and robustness through monthly updates and an increase in the amount of data requested. .

Further reading –

https://www.medicaid.gov/federal-policy-guidance/downloads/smd-13-004.pdf

Statistical Enrollment Data System – States submit quarterly and annual CHIP statistical data to CMS through the SEDS automated reporting system (U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, 2010, p. 47). Using forms provided by CMS, states report unduplicated counts of the number of children under age 19 who are enrolled in separate CHIPs and Medicaid expansion CHIPs. SEDS is a web-based system maintained by CMS since 2000 that collects new and total Medicaid and CHIP enrollment data from states on a quarterly basis. States must submit quarterly enrollment data within 30 days after the end of the fiscal quarter and aggregate annual data within 30 days after the end of the fourth quarter.46 This analysis uses quarterly and annual total enrollment data from three of the SEDS reporting forms and, to our knowledge, is the first analysis to do so.

Further reading –

https://www.ncbi.nlm.nih.gov/books/NBK209626/

Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to the delivery of early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders. SBIRT can be flexibly applied; therefore, it can be delivered in many clinical care settings. SBIRT has been adapted for use in hospital emergency settings, primary care centers, office- and clinic-based practices, and other community settings, providing opportunities for early intervention with at-risk substance users before more severe consequences occur. In addition, SBIRT interventions can include the provision of brief treatment for those with less severe SUDs and referrals to specialized substance abuse treatment programs for those with more severe SUDs.

Further reading –

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801194/

A request for proposal (RFP) is a document that solicits proposal, often made through a bidding process, by an agency or company interested in procurement of a commodity, service, or valuable asset, to potential suppliers to submit business proposals.

Further reading –

https://tenderspage.com/everything-need-know-rfp-process/

Qualifying Disabled and Working Individual – QDWI is a less common Medicare Savings Program (MSP) administered by each state’s Medicaid program. It pays the Medicare Part A premium for people who are under 65, have a disabling impairment, continue to work, and are not otherwise eligible for Medicaid.

Further reading –

https://www.benefits.gov/benefits/benefit-details/6180

A resident’s personal needs allowance is an amount required to be deducted from the computation of a resident’s patient liability to be used for the purchase of goods and services of the individual’s choosing that are not covered under Medicare or Medicaid. Personal Need Allowance (PNA) Accounts and Other Resident Funds for Nursing Facilities (NFs)” paragraph (B)(2) states
that “The PNA account is the exclusive property of the resident, who may use the funds in the account as he or she chooses to meet personal needs.”(emphasis added) Examples of items and services that the resident may request which would be chargeable to their PNA account includes, but is not limited to, items such as personal clothing, reading materials, and social events or entertainment offered outside of the facility’s activities program.

Though not required to, the resident may request the assistance of the NF to manage their PNA account. If the resident requests such assistance through written authorization, the funds still remain the property of the resident to use as they choose and are to be released, up to and including the resource limit amount, to that resident upon discharge. OAC 5101:3-3-16.5(G)(2) specifically states that “Other than for items and services that the resident has requested and that may be charged to the resident’s PNA account in accordance with this rule, a NF provider shall not withhold PNA account funds to pay any outstanding balance a resident owes the provider at the time of discharge.”(emphasis added) Likewise, upon the death of the resident, the balance of the resident’s PNA funds become a part of the deceased resident’s estate.

Further reading –

https://www.cga.ct.gov/PS99/rpt%5Colr%5Chtm/99-R-0025.htm

The Total Cost of Care (TCOC) includes all costs associated with treating members including professional, facility inpatient and outpatient, pharmacy, lab, radiology, ancillary and behavioral health services.

Further reading –

https://www.qualitymeasures.ahrq.gov/summaries/summary/38363?