CMS-10444 Minimum Data Set HI

Minimum Data Set for Medicaid Incentives for Prevention of Chronic Diseases Program Grantees

MIPCD_MDS_Data_Elements_HI_07232012_508

MEDICAID INCENTIVES FOR PREVENTION OF CHRONIC DISEASES (MIPCD) MINIMUM DATA SET

OMB: 0938-1184

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MEDICAID INCENTIVES FOR PREVENTION OF CHRONIC DISEASES (MIPCD)

MINIMUM DATA SET – Hawaii


A. Core Modules

Table A1. Record Identification

Name

Definition

Additional Description

Width

Type

Value/Format

Rec_Var_1

State Abbreviation

US Postal Service state abbreviation. For e.g., California is CA

2

String

xx

Rec_Var_2

Reporting Quarter

Current reporting quarter


Provide the date of the first day of the quarter. For example, 01012012 for data from the first quarter of 2012.

8

String/ Numeric

MMDDYYYY



Rec_Var_3



Record Trail

Sequence of quarterly record of the enrollee


For e.g., the record for the third quarter of enrollment for an enrollee will be coded as 3.


At the end of the first quarter of enrollment, two records are to be furnished for an enrollee - a baseline record (code = 0) and the end-of-first quarter record (code = 1). Thereafter, only one record is generated each quarter.

2

Numeric

0 (Baseline)

1 (Quarter 1)

2 (Quarter 2)

3 (Quarter 3)

4 (Quarter 4)

5 (Quarter 5)

6 (Quarter 6)

7 (Quarter 7)

8 (Quarter 8)

9 (Quarter 9)

10 (Quarter 10)

11 (Quarter 11)

12 (Quarter 12)

13 (Quarter 13)

14 (Quarter 14)

15 (Quarter 15)

16 (Quarter 16)

17 (Quarter 17)

18 (Quarter 18)

19 (Quarter 19)

20 (Quarter 20)

21 (Post-program follow up at 6 months)

22 (Post-program follow up at 12 months)

23 (Post-program follow up – month not specified)

99 (Missing/unknown)

Rec_Var_4


Program Completion Quarter

Quarter of completing the MIPCD program


Provide the date of the first day of the quarter during which the enrollee completes the program. For example, 01012012 for data from the first quarter of 2012.


If the enrollee has not completed the program yet, code 88888888 (N/A) may be provided.

8

String/ Numeric

MMDDYYYY

88888888 (N/A)

99999999 (Missing/unknown)

Rec_Var_5

Enrollment Sequence

Current enrollment sequence of the participant


Some states allow participants to reenroll after discontinuing participation for a significant period of time. Some states count this reenrollment as the continuation of the original enrollment, while other states consider this as a separate enrollment. For participants from states where reenrollment is counted as a separate enrollment, the actual sequence of enrollment is to be provided. For e.g., a participant’s second enrollment is to be coded as 2. For all other states, code 1 is to be entered.

1

Numeric

1 (Single enrollment)

x (Sequence of enrollment)

9 (Missing/unknown)


Rec_Var_6

Unique participant ID

Participant’s unique program ID

(Medicaid ID)

15

String

xxxxxxxxxxxxxxx




Table A2. Demographic Information and Medicaid Status

Name

Definition

Additional Description

Width

Type

Value/Format

Core_Var_1

Date of Birth


8

String/ Numeric

MMDDYYYY


99999999 (Missing/unknown)

Core_Var_2

Gender


1

Numeric

1 (Male)

2 (Female)

9 (Missing/unknown)

Core_Var_3

Race


1

Numeric

1 (White)

2 (Black or African American)

3 (American Indian or Alaska Native)

4 (Asian)

5 (Native Hawaiian or Other Pacific Islander)

6 (Multiple races)

9 (Missing/unknown)

Core_Var_4

Ethnicity


1

Numeric

0 (Not Hispanic or Latino)

1 (Hispanic or Latino)

9 (Missing/unknown)

Core_Var_5

Educational Attainment

Highest grade completed


Only applicable to states that collect this information.

1

Numeric

1 (No formal schooling)

2 (Elementary school)

3 (Some high school)

4 (High school graduate/GED)

5 (Some college or 2 yr degree)

6 (Bachelor's degree)

7 (Post college degree)

9 (Missing/unknown)

Core_Var_6

Diabetes at Baseline

Whether had diabetes at baseline


State can use its own definition of the condition depending on data availability.

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Core_Var_7

Hypertension at Baseline

Whether had high blood pressure at baseline


State can use its own definition of the condition depending on data availability.

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Core_Var_8

Heart Disease at Baseline

Whether had heart disease at baseline


State can use its own definition of the condition depending on data availability.

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Core_Var_9

Smoking Status at Baseline

Whether a smoker at baseline


State can use its own definition of the condition depending on data availability.

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Core_Var_10

Date of Lapse of Medicaid Eligibility

Date of losing Medicaid eligibility during the quarter

8

String/ Numeric

MMDDYYYY


88888888

(N/A)


99999999 (Missing/unknown)

Core_Var_11

Date of Regaining Medicaid Eligibility

Date of regaining Medicaid eligibility during the quarter

8

String/ Numeric

MMDDYYYY


88888888

(N/A)


99999999 (Missing/unknown)



B. State-specific Modules

Table B1. Enrollment Status

Name

Definition

Additional Description

Width

Type

Value/Format

Enroll_Var_1

Program Eligibility

Code that best describes program eligibility category




2

Numeric

8 (Diabetes)


Enroll_Var_2



Outreach

Source of outreach and recruitment into the program




2

Numeric

1 (Direct-to-participant outreach telephone call by Medicaid managed care organization)

2 (Direct-to-participant outreach telephone call by program implementing/outreach organization such as the YMCA),

3 (Direct-to-participant outreach mailing by Medicaid managed care organization),

4 (Provider outreach at medical home/ primary care practice/specialty care practice/clinic),

5 (Provider outreach at Federally Qualified Community Health Center), &

6 (Outreach during health education class or event)

7 (Outreach during community screening, health fairs)

99 (Missing/unknown)

Enroll_Var_3

Program Arm

Code of program arm


Each arm of the program to be coded 1, 2, 3 etc. with sufficient specificity so that each person can only be in one mutually exclusive category at a time.

2

Numeric

1 (CHC – HI PRAISE for Persons with Diabetes)

2 (Private Provider HI PRAISE Cross-Over Study: T1 (Coaching) )

3 (Private Provider HI PRAISE Cross-Over Study: T2 (Coaching + Incentives))

99 (Missing/unknown)

Enroll_Var_3a

Cross-over Status of Site

Code of the order in which the intervention site where the participant is enrolled crosses over if he/she is enrolled in the Private Provider HI PRAISE Cross-Over Study

1

Numeric

1 (T1 (Coaching) to T2 (Coaching + Incentives))

2 (T2 (Coaching + Incentives) to T1 (Coaching))

9 (Missing/unknown)

Enroll_Var_3b

Cross-over Status of Enrollee

Whether the enrollee crossed over between T1 and T2

1

Numeric

1 (Yes)

2 (No)

9 (Missing)

Enroll_Var_3c

Date of Cross-over

Date on which the enrollee (i.e., her site) crossed over

8

String/ Numeric

MMDDYYYY

88888888

(N/A)

99999999 (Missing/unknown)

Enroll_Var_4



Tobacco Cessation


Tobacco cessation is a prevention goal

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Enroll_Var_5

Weight Control

Controlling or reducing weight is a prevention goal


1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Enroll_Var_6

Lower Cholesterol

Lowering cholesterol levels is a prevention goal


1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Enroll_Var_7

Lower Blood Pressure

Lowering blood pressure is a prevention goal


1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Enroll_Var_8

Diabetes Control


Avoiding/managing diabetes is a prevention goal

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Enroll_Var_9

Manage Behavioral Health

Controlling and managing behavioral health conditions is a prevention goal

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Enroll_Var_10

Provider Agency

Name of the agencies providing the program services. For e.g., YMCA, xxx clinic


2

Numeric

11 (KPHC)

12 (KKV)

13 (Koolauloa)

14 (Waianae)

15 (Waikiki)

16 (Waimanalo)

17 Queen Emma Clinic

18 (Straub Clinic)

19 (Physician Center at Mililani and WGH)

21 (CC Maui)

22 (Hana health)

23 (Maui Medical Group)

31 (Hoolalahui Hawaii)

32 (Kauai Medical Clinic)
41 (Molokai CHC)

51 (Lanai CHC)

61 (Bay clinic)

62 (Hamakua)

63 (West Hawaii CHC)

64 Alii Health Center

99 (Missing/unknown)

Enroll_Var_10a

MCO Status

Medicaid Managed Care Organization status

1

Numeric

1 (Medicaid FFS)

2(United Healthcare QEXA)

3 (United Healthcare Quest)

4 (Ohana QEXA)

5 (Ohana Quest)

6 (AlohaCare Quest)

7 (HMSA Quest)

8 (Kaiser Quest)

9 (Missing/unknown)

Enroll_Var_11

Date of Current Enrollment

Date of enrollment in the program


Date of current (latest) enrollment for those participants for whom the current enrollment is not their first enrollment in the demonstration.


(Since multiple enrollments are not possible for HI, this date is that of the one and only enrollment into Hi-Praise)

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Enroll_Var_12



Program of Most Recent Prior Enrollment

Code of program arm of most recent prior enrollment in the program for those participants for whom the current enrollment is not their first enrollment. For those participants whose current enrollment is their first enrollment, code 88 (N/A) may be provided.


(Decided not relevant for HI as it envisions only single enrollments.)

2

String

88 (N/A)



Enroll_Var_13

Date of Most Recent Prior Enrollment

Date of enrolling in the most recent prior enrollment in the program. For those participants whose current enrollment is their first enrollment, code 88888888 (N/A) may be provided.


(Decided not relevant for HI as it envisions only single enrollments.)

8

String/ Numeric

888888888 (N/A)


Enroll_Var_14

Reason for Most Recent Prior Disenrollment

The reason for disenrolling from the most recent prior enrollment in the program. For those participants whose current enrollment is their first enrollment, code 88 (N/A) may be provided.


(Decided not relevant for HI as it envisions only single enrollments.)

2

Numeric

88 (N/A)



Table B2. Service Utilization

Name

Definition

Additional Description

Width

Type

Value/Format

Serv_Var_1

Service No. 1 - Number of Units

Consultation with health coaches

2

Numeric

xx

88 (N/A)

99 (Missing/unknown)

Serv_Var_2

Service No. 2 - Number of Units

Blood test

2

Numeric

xx

88 (N/A)

99 (Missing/unknown)

Serv_Var_3

Service No. 3 - Number of Units

Diabetes education session – individual

2

Numeric

xx

88 (N/A)

99 (Missing/unknown)

Serv_Var_4

Service No. 4 - Number of Units

Diabetes education session – group

2

Numeric

xx

88 (N/A)

99 (Missing/unknown)

Serv_Var_5

Service No. 5 - Number of Units

Smoking cessation counseling - individual

2

Numeric

xx

88 (N/A)

99 (Missing/unknown)

Serv_Var_6

Service No. 6 - Number of Units

Smoking cessation counseling – group

2

Numeric

xx

88 (N/A)

99 (Missing/unknown)

Serv_Var_7

Service No. 7 - Number of Units

Behavioral health counseling session

2

Numeric

xx

88 (N/A)

99 (Missing/unknown)

Serv_Var_8

Service No. 8 - Number of Units

Retinal eye exam visit

2

Numeric

xx

88 (N/A)

99 (Missing/unknown)



Table B3. Incentives

Name

Definition

Additional Description

Width

Type

Value/Format

Incent_Var_1

Incentive No. 1 - Dollar Value

Influenza and /or pneumococcal vaccination ($20)

4

Numeric

xxxx

8888 (N/A)

9999 (Missing/unknown)

Incent_Var_1a

Incentive No. 1 - Item

Influenza and /or pneumococcal vaccination ($20)

1

Numeric

1 (Dollars)

2 (Gift Cards)

3 (Gift Certificates)

4 (Gift Items)

5 (Vouchers)

6 (Other)

8 (N/A)

9 (Missing)

Incent_Var_2

Incentive No. 2 - Dollar Value

Retinal eye exam ($20)

4

Numeric

xxxx

8888 (N/A)

9999 (Missing/unknown)

Incent_Var_2a

Incentive No. 2 - Item

Retinal eye exam ($20)

1

Numeric

1 (Dollars)

2 (Gift Cards)

3 (Gift Certificates)

4 (Gift Items)

5 (Vouchers)

6 (Other)

8 (N/A)

9 (Missing)

Incent_Var_3

Incentive No. 3 - Dollar Value

Cholesterol test ($20)

4

Numeric

xxxx

8888 (N/A)

9999 (Missing/unknown)

Incent_Var_3a

Incentive No. 3 - Item

Cholesterol test ($20)

1

Numeric

1 (Dollars)

2 (Gift Cards)

3 (Gift Certificates)

4 (Gift Items)

5 (Vouchers)

6 (Other)

8 (N/A)

9 (Missing)

Incent_Var_4

Incentive No. 4 - Dollar Value

HbA1c test ($20)

4

Numeric

xxxx

8888 (N/A)

9999 (Missing/unknown)

Incent_Var_4a

Incentive No. 4 - Item

HbA1c test ($20)

1

Numeric

1 (Dollars)

2 (Gift Cards)

3 (Gift Certificates)

4 (Gift Items)

5 (Vouchers)

6 (Other)

8 (N/A)

9 (Missing)

Incent_Var_5

Incentive No. 5 - Dollar Value

Decrease in HbA1c to 7 or by 1 percentage point ($20)

4

Numeric

xxxx

8888 (N/A)

9999 (Missing/unknown)

Incent_Var_5a

Incentive No. 5 - Item

Decrease in HbA1c to 7 or by 1 percentage point ($20)

1

Numeric

1 (Dollars)

2 (Gift Cards)

3 (Gift Certificates)

4 (Gift Items)

5 (Vouchers)

6 (Other)

8 (N/A)

9 (Missing)

Incent_Var_6

Incentive No. 6 - Dollar Value

Attending smoking cessation session ($25)

4

Numeric

xxxx

8888 (N/A)

9999 (Missing/unknown)

Incent_Var_6a

Incentive No. 6 - Item

Attending smoking cessation session ($25)

1

Numeric

1 (Dollars)

2 (Gift Cards)

3 (Gift Certificates)

4 (Gift Items)

5 (Vouchers)

6 (Other)

99 (Missing)

Incent_Var_7

Incentive No. 7 - Dollar Value

Attending behavioral health counseling session ($25)

4

Numeric

xxxx

8888 (N/A)

9999 (Missing/unknown)

Incent_Var_7a

Incentive No. 7 - Item

Attending behavioral health counseling session ($25)

1

Numeric

1 (Dollars)

2 (Gift Cards)

3 (Gift Certificates)

4 (Gift Items)

5 (Vouchers)

6 (Other)

99 (Missing)

Incent_Var_8

Incentive No. 8 - Dollar Value

Attending first diabetes education session ($25)

4

Numeric

xxxx

8888 (N/A)

9999 (Missing/unknown)

Incent_Var_8a

Incentive No. 8 - Item

Attending first diabetes education session ($25)

1

Numeric

1 (Dollars)

2 (Gift Cards)

3 (Gift Certificates)

4 (Gift Items)

5 (Vouchers)

6 (Other)

99 (Missing)

Incent_Var_9

Incentive No. 9 - Dollar Value

Attending diabetes education classes


Give the total amount paid during the quarter on all the different items

4

Numeric

xxxx

8888 (N/A)

9999 (Missing/unknown)

Incent_Var_9a

Incentive No. 8 – Item 1

Attending diabetes education classes (Food)

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Incent_Var_9b

Incentive No. 8 – Item 2

Attending diabetes education classes (Water bottle)

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Incent_Var_9c

Incentive No. 8 – Item 3

Attending diabetes education classes (Pedometer)

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Incent_Var_9d

Incentive No. 8 – Item 4

Attending diabetes education classes (Household items)

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Incent_Var_9e

Incentive No. 8 – Item 5

Attending diabetes education classes (Cosmetics)

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Incent_Var_9f

Incentive No. 8 – Item 6

Attending diabetes education classes (Stationery)

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Incent_Var_9g

Incentive No. 8 – Item 7

Attending Diabetes education classes (Diabetes specialty items)

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Incent_Var_9h

Incentive No. 8 – Item 8

Attending diabetes education classes (Other)

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Incent_Var_10

Incentive No. 10 - Dollar Value

Weight loss of 7% ($50)

4

Numeric

xxxx

8888 (N/A)

9999 (Missing/unknown)

Incent_Var_10a

Incentive No. 10 - Item

Weight loss of 7% ($50)

1

Numeric

1 (Dollars)

2 (Gift Cards)

3 (Gift Certificates)

4 (Gift Items)

5 (Vouchers)

6 (Other)

8 (N/A)

9 (Missing)



Table B4. Health and Behavioral Outcomes

Name

Definition

Additional Description

Width

Type

Value/Format

Outcome_Var_1

Height

Inches

3

Numeric

xx

99 (Missing/unknown)

Outcome_Var_2

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_3

Weight

Pounds

4

Numeric

xxxx

9999 (Missing/unknown)

Outcome_Var_4

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_5

BMI

Body mass index

3

Numeric

xxx

999 (Missing/unknown)

Outcome_Var_6

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_7

Systolic Blood Pressure

mm Hg

3

Numeric

xxx

999 (Missing/unknown)

Outcome_Var_8

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_9

Diastolic Blood Pressure

mm Hg

3

Numeric

xxx

999 (Missing/unknown)

Outcome_Var_10

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_11

Fasting Blood Sugar

mg/dL

3

Numeric

xxx

999 (Missing/unknown)

Outcome_Var_12

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_13

Random Blood Sugar

mg/dL

3

Numeric

xxx

999 (Missing/unknown)

Outcome_Var_14

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_15

Hemoglobin A1c

Percentage

4

Numeric

xxxx

9999 (Missing/unknown)

Outcome_Var_16

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_17

Total Cholesterol

mg/dL

3

Numeric

xxx

999 (Missing/unknown)

Outcome_Var_18

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_19

Triglycerides

mg/dL

4

Numeric

xxxx

9999 (Missing/unknown)

Outcome_Var_20

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_21

LDL

mg/dL

3

Numeric

xxx

999 (Missing/unknown)

Outcome_Var_22

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_23

HDL

mg/dL

3

Numeric

xxx

999 (Missing/unknown)

Outcome_Var_24

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_25

Urine for Microalbumin

Mg

7

Numeric

xxxx.xx

9999.99 (Missing/unknown)

Outcome_Var_26

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_27

DM Retinopathy

Whether has DM retinopathy

1

Numeric

1 (Yes)

2 (No)

9 (Missing/unknown)

Outcome_Var_28

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_29

Smoking Cessation

Whether quit smoking for six months or more

1

Numeric

1 (Yes)

2 (No)

8 (N/A)

9 (Missing/unknown)

Outcome_Var_30

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_31

Influenza Vaccination

Whether received

1

Numeric

1 (Yes)

2 (No)

9 (Missing/unknown)

Outcome_Var_32

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)

Outcome_Var_33

Pneumococcal Vaccination

Whether received

1

Numeric

1 (Yes)

2 (No)

9 (Missing/unknown)

Outcome_Var_34

Date of Measurement

Date of most recent measurement

8

String/ Numeric

MMDDYYYY

99999999 (Missing/unknown)




16

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleMedicaid Incentives for Prevention of Chronic Diseases Hawaii Minimum Data Set
SubjectMIPCD MDS Data Elements, Hawaii, 07/23/2012
AuthorCMS
File Modified0000-00-00
File Created2021-01-30

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