CMS-10444 Minimum Data Set NY

MEDICAID INCENTIVES FOR PREVENTION OF CHRONIC DISEASES (MIPCD)

MINIMUM DATA SET – New York

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 entered.	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	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.	2	Numeric	88 (N/A)
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) 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) 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) 9 (Missing/unknown)
Core_Var_9	Smoker 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) 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	1 (Smoker) 8 (Diabetes) 9 (Pre-diabetes or at risk for diabetes) 14 (High blood pressure) 99 (Missing/unknown)
Enroll_Var_2	Outreach	Source of outreach and recruitment into the program	2	Numeric	88 (N/A)
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 (Smoking – Schedule A) 2 (Smoking – Schedule B) 3 (Smoking – Schedule C) 4 (Smoking – Schedule D) 5 (Diabetes Prevention – Schedule A) 6 (Diabetes Prevention – Schedule B) 7 (Diabetes Prevention – Schedule C) 8 (Diabetes Prevention – Schedule D) 9 (Diabetes Management – Schedule A) 10 (Diabetes Management – Schedule B) 11 (Diabetes Management – Schedule C) 12 (Diabetes Management – Schedule D) 13 (Hypertension – Schedule A) 14 (Hypertension – Schedule B) 15 (Hypertension – Schedule C) 16 (Hypertension – Schedule D) 99 (Missing/unknown)
Enroll_Var_3a	Simultaneous Enrollment	Whether enrollee is simultaneously enrolled in two program arms. For e.g., simultaneously enrolled in the diabetes and hypertension programs that are operating in the same boroughs	1	Numeric	1 (Yes) 2 (No) 9 (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) NY to provide free text or codes, if they consider the variable relevant	50/2	String/Numeric	Free text/codes
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.	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.	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.	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.	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	Diabetes Prevention Educational Session	2	Numeric	xx 88 (N/A) 99 (Missing/unknown)
Serv_Var_2	Service No. 2 - Number of Units	Smoking Cessation Counseling Session	2	Numeric	xx 88 (N/A) 99 (Missing/unknown)
Serv_Var_3	Service No. 3 - Number of Units	Smoking Prescription Filled (NRT, Chantix, Zyban) Provide the number of times filled	2	Numeric	xx 88 (N/A) 99 (Missing/unknown)
Serv_Var_4	Service No. 4 - Number of Units	Attend Diabetes Management Primary Care Appointment	2	Numeric	xx 88 (N/A) 99 (Missing/unknown)
Serv_Var_5	Service No. 5 - Number of Units	Diabetes Prescription Filled Provide the number of times filled	2	Numeric	xx 88 (N/A) 99 (Missing/unknown)
Serv_Var_6	Service No. 6 - Number of Units	Attend Hypertension Primary Care Appointment	2	Numeric	xx 88 (N/A) 99 (Missing/unknown)
Serv_Var_7	Service No. 7 - Number of Units	Hypertension Prescription Filled Provide the number of times filled	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	Attend 4 Diabetes Prevention Education Sessions (Schedule A, $62.50)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_2	Incentive No. 2 - Dollar Value	Attend 4 Diabetes Prevention Education Sessions (Schedule C, $31.25)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_3	Incentive No. 3 - Dollar Value	Decrease in Weight by 5% (Schedule A, $62.50)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_4	Incentive No. 4 - Dollar Value	Decrease in Weight by 5% (Schedule C, $31.25)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_5	Incentive No. 5 - Dollar Value	Smoking Cessation Counseling Session or Monthly Prescription Fill (Schedule A, $50)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_6	Incentive No. 6 - Dollar Value	Smoking Cessation Counseling Session or Monthly Prescription Fill (Schedule C, $25)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_7	Incentive No. 7 - Dollar Value	First Negative Cotinine Test (Schedule A, $100)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_8	Incentive No. 8 - Dollar Value	Second Negative Cotinine Test (Schedule C, $150)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_9	Incentive No. 9 - Dollar Value	First Negative Cotinine Test (Schedule A, $50)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_10	Incentive No. 10 - Dollar Value	Second Negative Cotinine Test (Schedule C, $75)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_11	Incentive No. 11 - Dollar Value	Attend Primary Care Appointment or Prescription Fill – Diabetes Management (Schedule A, $50)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_12	Incentive No. 12 - Dollar Value	Attend Primary Care Appointment or Prescription Fill – Diabetes Management (Schedule C, $25)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_13	Incentive No. 13 - Dollar Value	Decrease in HbA1c by 0.6% or Maintaining HbA1c under 8% (Schedule A, $75)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_14	Incentive No. 14 - Dollar Value	Decrease in HbA1c by 0.6% or Maintaining HbA1c under 8% (Schedule C, $34.50)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_15	Incentive No. 15 - Dollar Value	Attend Primary Care Appointment or Prescription Fill – Hypertension (Schedule A, $50)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_16	Incentive No. 16 - Dollar Value	Attend Primary Care Appointment or Prescription Fill – Hypertension (Schedule C, $25)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_17	Incentive No. 17 - Dollar Value	Decrease in Systolic BP by 10mmHg or Achieve Target Blood Pressure below the JNC-8 Targets (systolic blood pressure <140 for non-diabetics; <130 for diabetics) (Schedule A, $50)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)
Incent_Var_18	Incentive No. 18 - Dollar Value	Decrease in Systolic BP by 10mmHg or Achieving Target Blood Pressure below the JNC-8 Targets (systolic blood pressure <140 for non-diabetics; <130 for diabetics) (Schedule C, $25)	4	Numeric	xxxx 8888 (N/A) 9999 (Missing/unknown)

Table B4. Health and Behavioral Outcomes

Name	Definition	Additional Description	Width	Type	Value/Format
Outcome_Var_1	Weight	Pounds	3	Numeric	xxx 888(N/A) 999 (Missing/unknown)
Outcome_Var_2	Date of Measurement	Date of most recent measurement	8	String/Numeric	MMDDYYYY 99999999 (Missing/unknown)
Outcome_Var_3	Negative Cotinine Test	Whether Cotinine test negative	1	Numeric	1 (Yes) 2 (No) 8 (N/A) 9 (Missing/unknown)
Outcome_Var_4	Date of Measurement	Date of most recent measurement	8	String/Numeric	MMDDYYYY 99999999 (Missing/unknown)
Outcome_Var_5	HbA1c	Percentage	4	Numeric	xxxx 8888 (N/A) 9999 (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 888(N/A) 999 (Missing/unknown)
Outcome_Var_8	Date of Measurement	Date of most recent measurement	8	String/Numeric	MMDDYYYY 99999999 (Missing/unknown)

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