Category: MAOTD (Medicaid Acronym of the Day)

The National Center for Health Statistics (NCHS) is a principal agency of the U.S. Federal Statistical System which provides statistical information to guide actions and policies to improve the health of the American people.

NCHS is housed within the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services (HHS). It is headquartered at University Town Center in Hyattsville, Maryland, just outside Washington, D.C. In 1960, the National Office of Vital Statistics and the National Health Survey merged to form the National Center for Health Statistics (NCHS). NCHS is one of 13 principal statistical agencies in the federal government. The Center has been located in a number of organizations within the Department of Health and Human Services (HHS), and since 1987 has been part of the Centers for Disease Control and Prevention (CDC).

NCHS collects data with surveys, from other agencies and U.S. states, from administrative sources, and from partnerships with private health partners. NCHS collects data from birth and death records, medical records, interview surveys, and through direct physical examinations and laboratory testing. These diverse sources give perspectives to help understand the U.S. population’s health, health outcomes, and influences on health.

Further reading –

https://www.cdc.gov/nchs/index.htm

The National Correct Coding Initiative (NCCI) is a CMS program designed to prevent improper payment of procedures that should not be submitted together. There are two categories of edits:

Physician Edits: these code pair edits apply to physicians, non-physician practitioners, and Ambulatory Surgery Centers
Hospital Outpatient Prospective Payment System Edits (Outpatient Edits): these edits apply to the following types of bills: Hospitals (12X and 13X), Skilled Nursing Facilities (22X and 23X), Home Health Agencies Part B (34X), Outpatient Physical Therapy and Speech Language Pathology Providers (74X), and Comprehensive Outpatient Rehabilitation Facilities (75X).

Both the physician and outpatient edits can be split into two further code pair categories:

Column1/Column2 Code Pairs: these code pairs were created to identify unbundled services. The name is derived from the fact that the code pairs are separated into two columns; Column 1 contains the most comprehensive code, and Column 2 contains component services already covered by that more-comprehensive code.

These code pairs are further categorized into two sets:

Modifier: the appropriate use of a modifier allows these code pair to be reported together. In most cases, the -59 modifier is used, although there are other acceptable modifiers. These modifiers must be supported by documentation in the medical record.

No Modifiers: these code pairs should never be reported together, regardless of modifiers.

Mutually Exclusive Code Pairs (MEC): these code pairs should not be reported together because they are mutually exclusive of each other.
NCCI code pairs must match on member, provider, and date of service. CMS maintains tables of code pair edits and updates these tables on a quarterly basis.

Further reading –

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

The National Child Abuse and Neglect Data System (NCANDS) is a voluntary data collection system that gathers information from all 50 states, the District of Columbia, and Puerto Rico about reports of child abuse and neglect. NCANDS was established in response to the Child Abuse Prevention and Treatment Act of 1988. The data are used to examine trends in child abuse and neglect across the country, and key findings are published in our Child Welfare Outcomes Reports to Congress and annual Child Maltreatment reports.

Further reading –

https://www.acf.hhs.gov/cb/research-data-technology/reporting-systems/ncands

The National Association of States United for Aging and Disabilities (NASUAD) was founded in 1964 under the name National Association of State Units on Aging (NASUA). In 2010, the organization changed its name to NASUAD in an effort to formally recognize the work that the state agencies were undertaking in the field of disability policy and advocacy. Today, NASUAD represents the nation’s 56 state and territorial agencies on aging and disabilities and supports visionary state leadership, the advancement of state systems innovation and the articulation of national policies that support home and community based services for older adults and individuals with disabilities.

Further reading –

http://www.nasuad.org/

National Average Drug Acquisition Cost Survey – The NADAC survey process focuses on retail community pharmacy drug ingredient costs. The survey collects acquisition costs for covered outpatient drugs purchased by retail community pharmacies, which include invoice purchase prices from independent and chain retail community pharmacies.

Included in the Survey of Retail Prices, in addition to a survey of the cost pharmacies incur to purchase drugs, CMS collects information on consumer prices for the purchase of drugs. This survey focuses on the collection of retail community pharmacy prices charged to consumers and the calculation of consumer unit drug prices.

Further reading –

https://www.medicaid.gov/medicaid-chip-program-information/by-topics/prescription-drugs/ful-nadac-downloads/nadacmethodology.pdf

Collaborative Application Lifecycle Tool – The CALT is a collaborative tool that creates a centralized repository for storing, collaborating on and sharing deliverables and artifacts from IT projects in support of Medicaid administration and establishment of Exchanges. CMS recently deployed the CALT on a secure cloud computing environment.

Within the CALT, CMS has created the Medicaid State Collaborative Community to allow States the opportunity to leverage, share, and collaborate on Medicaid information technology (IT) systems development projects and to submit artifacts to the CALT for review and approval as required by the systems development lifecycle (SDLC) process. CMS established CALT as a centralized platform and provides its features and functions to all users – regardless of geographic location. CALT collaboration features allow States to manage systems development activities related to planning, developing, testing, implementing, and maintaining numerous Medicaid/Exchange IT software/system applications, and to communicate their progress and innovative ideas with other States. States can also share best practices and post documents such as MITA State Self-Assessments. Through the use of CALT, CMS will provide States with timely feedback and direct support for systems development projects.

Further reading –

https://calt.cms.gov/sf/sfmain/do/home

Testing Experience and Functional Tools – In March 2014, CMS awarded TEFT grants to nine states to test quality measurement tools and demonstrate e-health in Medicaid community-based long term services and supports (CB-LTSS). The grant program, spanning four years through March 2018, is designed to field test an experience of care survey and a set of functional assessment items, demonstrate personal health records, and create a standard electronic LTSS plan.

Further reading –

https://www.medicaid.gov/medicaid/ltss/teft-program/index.html

Preadmission Screening and Resident Review (PASRR) is a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care. PASRR requires that 1) all applicants to a Medicaid-certified nursing facility be evaluated for mental illness and/or intellectual disability; 2) be offered the most appropriate setting for their needs (in the community, a nursing facility, or acute care settings); and 3) receive the services they need in those settings. The PASRR Technical Assistance Center provides information in a variety of formats available from the link below, and offers free individual consultation to any state agency involved with PASRR, from simple questions to intensive on-site review and program design.

Further reading –

https://www.medicaid.gov/medicaid/ltss/institutional/pasrr/index.html

State Operations and Technical Assistance (SOTA) initiative was created to work through policy and operational changes required in Medicaid by the Affordable Care Act. In July 2015, CMS announced an enhancement to this initiative called SOTA 2.0 (PDF 212.83 KB).

The goal of SOTA 2.0 is to provide a smoother and more efficient experience for states when working across CMS on Medicaid-related issues. By creating a team that will organize itself around a state and can be accountable to them, we believe that the new SOTA 2.0 structure will provide states a more seamless experience for states as they work with CMS.

Further reading –

https://www.medicaid.gov/state-resource-center/state-operations-and-technical-assistance/index.html

Medicaid State Technical Assistance Teams – The staff in the Center for Medicaid and CHIP Services (CMCS) provides technical assistance to states on an ongoing basis on all Medicaid and CHIP topics. However, for several specific programs, CMCS has also contracted with outside entities to provide technical assistance to states on behalf of the Center.

Further reading –

https://www.medicaid.gov/state-resource-center/medicaid-state-technical-assistance/medicaid-state-technical-assistance.html