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TEAMKY Demonstration

Approval Period: January 1, 2025 through December 31, 2029

Page 114 of 155 The SUD demonstration is scheduled to begin July 2019. We are requesting data for the period July 2017-September 2023, i.e., beginning two years prior to implementation and continuing through the expiration of the demonstration waiver.

C.4. Data Sources

The core data for the evaluation will be Medicaid encounter data. These data will be supplemented with data from administrative vital statistics; a provider enrollment database; ongoing smaller- scale surveys of individuals enrolling in treatment for SUD; and a qualitative survey of Medicaid beneficiaries with SUD.

C.4.1. Medicaid encounter data Because most of Kentucky's Medicaid beneficiaries receive benefits administered by managed care organizations (MCOs), we will be using Kentucky Medicaid encounter data reported by these MCOs. These encounter data contain records of outpatient, emergency department, inpatient, and long-term care services provided for SUD, as well as prescription drugs dispensed. They also include information on billing providers (facilities and physicians) and on payments made to these providers by the MCOs.

In submitting its encounters to the state Medicaid Management Information System (MMIS), each MCO is required to submit data that follows a consistent format and that must pass a range of edits and audits. These validated encounter data then undergo state review for quality—including completeness/missingness assessments, internal consistency checks, and other data validation reviews—prior to submission by the state to the federal Transformed Medicaid Statistical Information System (T-MSIS). According to the state, "these processes… ensure a high level of confidence in the quality of the encounter data."6 Encounter data are available on a quarterly basis with a 6-month lag. Limitations of these data are that they do not include direct measures of health status or substance use.

C.4.2. Administrative vital statistics data Vital statistics data capture deaths attributable to accidental poisonings, including overdoses. These data are available on a quarterly basis with a 9-month lag. Limitations of these data are the measurement error in the attribution of overdose deaths to opioids.

C.4.3. Provider enrollment data Kentucky Medicaid will launch the Kentucky Medicaid Partner Portal Application (KY MPPA), a Medicaid provider enrollment system, in mid-2019. Data from KY MPPA will be available annually with a 6-month lag and will be used to cross-validate provider information obtained from Medicare claims. Prior to KY MPPA, provider enrollment was done through a manual reporting process. A limitation of this data source is that data on provider enrollment prior to implementation will need to be manually aggregated and processed to convert it into a format suitable for the evaluation.

C.4.4. Kentucky Treatment Outcome Study (KTOS) and Kentucky Opiate Replacement Treatment Outcome Study (KORTOS)