Qualitative Data Coding Scheme

ATTACHMENT I
QUALITATIVE DATA CODING SCHEME

Medicaid Emergency Psychiatric Demonstration Evaluation
Document Families and Code List
Document Families
Document Families
State
Alabama
California
Connecticut
District of Columbia
Illinois
Maine
Maryland
Missouri
North Carolina
Rhode Island
Washington
West Virginia
Multi-state
FMAP
FMAP 50%
FMAP 51-60%
FMAP 61-75%
Document Type
Report
MEPD PD interview
IMD POC interview
IMD front interview
IMD admin interview
ER front interview
ER admin interview
GH front interview
GH admin interview
UR interview
Beneficiary interview
Site Visit Round
Round 1
Round 2
IMD Size
Beds: 17-25
Beds: 26-50
Beds: 51-100
Beds: 101-200
Beds: 201-300
Beds: 301+

DEFINITION
All primary documents should belong to a “State” family

All primary documents should belong to a “FMAP” family
State has a federal Medicaid matching rate of 50%
State has a federal Medicaid matching rate between 51% and 60%
State has a federal Medicaid matching rate between 61% and 75%
All primary documents should belong to a “Document Type” family
Report submitted by the State to CMS. Includes proposals, State Operational Plans, and
IMPAQ progress reports
State or county demonstration staff interview
Interview with the point of contact at the participating IMD
Interview with frontline staff at the participating IMD
Interview with administrator at the participating IMD
Interview with frontline staff at the emergency room
Interview with administrator at the emergency room
Interview with frontline staff at the GH
Interview with administrator at the GH
Interview with Utilization Review Vendor or ASO staff
Beneficiary interview
Interview notes should belong to a “Site Visit Round” family

IMD interviews and Medical record reviews should belong to a “IMD Size” family
IMD with 17 to 25 beds
IMD with 26 to 50 beds
IMD with 51 to 100 beds
IMD with 101 to 200 beds
IMD with 201 to 300 beds
IMD with 301 or more beds

I-1

Code List
CODE
Respondent Context
Responsibilities
Responsibilities: MEPD
IMD
IMD: Characteristics
IMD: Outpatient
IMD: QI other
IMD: Patient
ER
ER: Characteristics
ER: Patient
GH
GH: Characteristics
GH: Patient
Beneficiary
State Context
State

State: Event
State: Politics
State: Policies
MH Sector
MH Sector: Payment

MH Sector: QI-other

DEFINITION
Interviewee’s job duties and/or role
(use sub-code for MEPD specific responsibilities)
MEPD specific job duties or role
IMD context needed to understand the environment the demonstration is operating
within
(use sub-codes when possible)
Describes characteristics of participating IMDs (e.g., ALOS, daily census, number of
beds, payer mix, type of hospital )
Describes IMD outpatient or step-down services that patients might be discharged to
Non-demonstration quality improvement activities driven by the hospital
Do NOT code federal, state, or regional activities
Describes characteristics of patients at IMDs (e.g., physical comorbidities, substance
use, residence)
Do NOT code for consumer description of their own characteristics
Emergency room context needed to understand the environment the demonstration is
operating within
(use sub-codes when possible)
Describes characteristics of emergency rooms (e.g., boarding times, time spent in
waiting rooms, number of beds, payer mix, presence of inpatient psychiatric unit for inhouse transfer)
Describes characteristics of patients at ERs (e.g., physical comorbidities, substance use,
insurance status, residence)
General hospital context needed to understand the environment the demonstration is
operating within
(use sub-codes when possible)
Describes characteristics of general hospitals (e.g., boarding times, number of beds,
payer mix)
Describes characteristics of patients at ERs (e.g., physical comorbidities, substance use,
insurance status, residence)
Beneficiary descriptions of themselves during beneficiary interviews (e.g., physical
comorbidities, substance use, insurance status, residence)
State environmental factors including attitudes, geography (urban, rural), and income.
(Use sub-code if possible)
A natural disaster or other crisis in the state that may impact the delivery, financing, or
utilization of mental health services. Events include the Sand Hook shooting and
Hurricane Sandy.
Elected officials and political appointees, state budget issues
Legislation or regulation that is proposed or passed
Mental health system context needed to understand the environment the
demonstration is operating within.
(Use sub-codes if possible.)
Funding of mental health services in the state. Includes funding of Medicaid stays at
IMDs prior to the demonstration and reimbursement for other level of care mental
health services under Medicaid (fee for service versus managed care, types of covered
services, payment rates)
Non-demonstration quality improvement activities at the federal, state, or regional

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CODE

MH Sector: Demand
MH Sector: Beds
MH Sector: Outpatient
MH Sector: Workforce
PH Sector
Processes and Procedures
New
Payment
Payment: IMDs
Payment: State
Outreach
Outreach: Counties
Outreach: IMDs
Outreach: Referral

Outreach: Referral from
State
Outreach: Referral from
IMD
Eligibility
Eligibility: Condition
Eligibility: Enrollment
Referral
Stabilization
Discharge

DEFINITION
level, including initiatives to reduce emergency room readmissions and to integrate
primary and behavioral health care
Demand for inpatient psychiatric services before the demonstration and changes in
demand during the demonstration
Availability of inpatient psychiatric beds. Include discussion of bed shortages and
emergency room and general hospital psychiatric boarding.
Availability and characteristics of community-based services including mental health
clinics, intensive outpatient programs (IOPs), partial hospitalization programs,
residential programs, and group homes
Availability of licensed mental health providers including psychologists, psychiatrics,
social workers, advanced practice nurses, and registered nurses
Physical health system context needed to understand the environment the
demonstration is operating within. Efforts could include medical home demonstrations
or state health IT activities. Do NOT code for mental health system context.
State or providers implemented a new process or changed existing procedures.
(Double-code with relevant process or procedure code)
Medicaid payments for services provided under the demonstration.
(Use sub-codes if possible.)
Medicaid reimbursement to IMDs for services provided under the demonstration.
Include discussion of new or adapted systems for processing payments.
CMS provision of federal matching funds to states for services provided under the
demonstration. Include discussion of changes to MMIS systems.
Efforts to encourage participation in the demonstration.
(Use sub-codes if possible.)
State-level outreach to counties or regions. Include descriptions of outreach activities
and reasons for targeting particular counties.
State or county outreach to IMDs. Include descriptions of how IMDs were selected and
outreach activities to IMDs.
Outreach to referral providers, such as emergency departments at general hospitals,
community-based providers, or crisis stabilization services. Include descriptions of
outreach activities and reasons for targeting particular referral providers.
(Use sub-codes if possible
State or county outreach to referral providers.
IMD outreach to referral providers.
Discussion of eligibility criteria for the demonstration
(Use sub-codes if possible)
Discussion of the change in eligibility criteria to allow beneficiaries who are a danger to
self or others but not homicidal or suicidal to participate
Discussion of the change in eligibility criteria to allow for individuals who are eligible for
Medicaid but not enrolled to participate
Process for referral and admission under the demonstration. Includes description of
pre-authorization procedures.
(Use sub-code if process was changed for the demonstration)
Process for stabilization and ongoing/concurrent authorization for patients under the
demonstration.
(Use sub-code if process was changed for the demonstration)
Description of discharge planning activities that occur during the inpatient stay. Do NOT
code for activities that occur post-discharge.

I-3

CODE
Post-discharge
Oversight

Stakeholders
Consumer
Social support
Peer support
Community

Collaboration
Experiences in Demo
Unexpected Demo Changes

DEFINITION
(Use sub-code if process was changed for the demonstration)
Post-discharge activities including after-care placements and follow-up care with
community-based providers.
(Use sub-code if process was changed for the demonstration)
State oversight of stabilization, discharge planning, and/or post-discharge
requirements. Oversight may be completed by a state agency, case manager, utilization
review vendor, or behavioral health organization.
(Use sub-code if process was changed for the demonstration)
Consumer involvement in treatment or discharge planning procedures.
(Double-code with process or procedure code)
Family or other social support network involvement in during treatment, discharge
planning, or post-discharge procedures.
(Double-code with process or procedure code)
Peer-support provided during treatment, discharge planning, or post-discharge.
(Double-code with process or procedure code)
Involvement of community-based providers or resources (e.g., social workers, case
workers, psychologists) during treatment,, discharge planning, or post-discharge
procedures.
(Double-code with process or procedure code)
Collaboration between the State, IMDs, and/or community-based services to plan or
implement the demonstration.
(Double-code with process or procedure code)
Double-code with other codes
State or IMD is doing something different than they had originally planned (e.g.,
adjusting strategies, timelines, or turnover in demo leadership)

Facilitators

Things that went well; positive factors that are helping the demonstration succeed. Do
NOT code facilitators of non demonstration activities.

Barriers

Things that haven’t gone well; negative factors/challenges; how overcame them; Do
NOT code barriers to non demonstration activities.

Good quote
Outcomes
Goals
Out

A good quote or example that nicely illustrates a point; a key insight
Double-code with other codes
Goals of the MEPD program
Things that happened as a result of demonstration
(Use sub-codes if possible.)
Change in access to inpatient psychiatric care. Includes description of the change in use
of IMDs
Change in the continuity of care for beneficiaries in need of inpatient psychiatric care.
Includes discussions of beneficiaries receiving inpatient care closer to their home
and/or outpatient services
Change in psychiatric boarding at emergency rooms
Change in psychiatric boarding at general hospitals
Change in quality of care provided by IMD
Change in average length of stay at the IMD
Change in readmission rate for psychiatric emergencies
Change in beneficiary health or functional status
Change in cost of inpatient or outpatient services
(Use sub-codes if possible.)

Out: Access
Out: Continuity
Out: ER boarding
Out: GH boarding
Out: Quality
Out: ALOS
Out: Readmission
Out: Health
Out: Costs

I-4

CODE
Out: Costs: State
Out: Costs: IMD
Out: Costs: Community
Out: Satisfaction
Other
Other

DEFINITION
Change in costs incurred by the state
Change in costs incurred by the IMD
Change in costs incurred by community-based providers and referral providers
Change in beneficiary satisfaction with inpatient psychiatric care. Includes changes in
satisfaction with treatment, discharge planning, and post-discharge procedures.
Use if no suitable code and text seems important for analysis (but it’s OK to not code)

I-5