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1995 Supplemental Table Notes

These notes relate to the supplemental tables available only on the electronic version of the Mental Health and Substance Abuse Services in Medicaid, 1995 tables that are available on SAMHSA's web site:

http://www.mentalhealth.samhsa.gov/publications/browse.asp?SubjectArea=Mental%20Health%20Publications

The format of this document is virtually the same in structure as the overall notes. It includes definitions and methodologies used in creating each table set that has not been previously defined in the main document. It contains the following sections:

• Definition of Terms
• Categorization Variables
• Description of Tables
• Data Quality Review
• Reasonability Analysis

Definition of Terms

Days of Care
These represent the days reported on an inpatient or other institutional claim paid for by Medicaid. This differs from Length of Stay (see below). Leave days (i.e., days paid for holding a bed in a hospital while a patient is released temporarily to another facility or home) are not included in the days of care counts. All paid days are included in these totals, even those from stays reporting the recipient was "still a patient."

Detox Claims
Detoxification claims were identified on the inpatient file using the primary procedure code field using the following ICD-9-CM procedure code values:

94.62 Alcohol detoxification
94.65 Drug detoxification
94.68 Combined alcohol and drug detoxification

Categorization Variables

Race/Ethnicity
White, Non Hispanic
Black, Non Hispanic
American Indian/Alaska Native
Asian/Pacific Islander
Hispanic
Unknown

Description of Tables

Table S1: MH/SA Users by Age Group and Race/Ethnicity
This table is similar to Table 1 with slightly different demographic groupings. It looks at race/ethnicity within specified age groups. The other variation in this table is that it reports percentages within age groups rather than across the overall population (e.g., percent of the under 21 MH only users who are Hispanic).

Table S2: Inpatient Detox Claims by Sex and Age Group
This table looks at claim level data and reports the number of claims with a primary procedure code for detoxification (detox)(see Definition of Codes for specific procedure codes used). It also looks at what percentage of substance abuse as well as MH/SA claims these represent. It should be noted that detox services could not be identified in all states. For states where these services are not identifiable, the table is included for completeness, but the appropriate cells are filled with "N/A." These states are not included in the "All State" set in order to keep the numerators and denominators consistent.

Table S3: Annual Institutional Paid Days of Care per MH/SA User by Type of Service and Age Group
Unlike the length of stay calculations reported for inpatient users in Table 8, this reports annual days of care for the four institutional types of service: Acute Inpatient, Institutional Psychiatric Facilities, ICF/MR and Nursing Facilities. The other difference is that this table reports "paid days" and not "total days of care". "Paid days" are those days that Medicaid is paying all or part of the care for the patient. If a State has limits on the number of days paid by Medicaid, (e.g., day limits) then the "paid days" would be less than the "total days of care." Furthermore, if a claim for the delivery of a baby includes both the mother's and baby's expenditures, the "paid days" may be the total of both patients' "paid days of care." The days are further broken down by age group.

• Only Primary Diagnosis was used to determine the cell in the table where stay is reported.
• The denominator for this table can be found in Table S4.
• Days do not include leave days.

Table S4: MH/SA Users of Institutional Services by Type of Service and Age Group
This counts only users with one or more covered days of care (i.e., "paid days of care"). This table serves as the denominator for Table S3 for the same institutional types of service categories by age group.

• Only the Primary Diagnosis on a claim was used to determine how to categorize the user (i.e., MH or SA).
• This table differs from Table 7, which requires a discharge regardless of the number of days of care (see note under Table 7 for further information).
• A person will be counted once in every cell for which they have a claim that applies.

Table S5: Distribution of MH/SA Expenditures (Chart)
This graph shows the distribution of MH/SA expenditures across users. The measures are represented as percentages (i.e., what percent of users account for what percent of expenditures).

Table S6: High Cost MH/SA Users by Basis of Eligibility and Age Group
This table is similar to Table 10 except that the demographic category used is the "Basis of Eligibility" which defines the enrollment category under which the enrollee/recipient was eligible for Medicaid.

Table S7: High Cost MH/SA Users by Diagnostic Category and Age Group
This table is the same as Table 2 except that the population included are the MH/SA users included in the top 10% of Equivalent Medicaid Enrollees.

Data Quality Review

This section describes areas that require further explanation or problems that were encountered during the creation of these tables.

Table 7 vs. Table S4 User Counts
As described in the descriptions of Table 7 and Table S4, a user can be defined two different ways. A user can be defined as someone having a "stay" in the period of study (Table 7 definition) or a user can be defined as having a "covered day of care" in the study period (Table S4 definition). Usually, the result is the same. However, given the various reimbursement methodologies currently in use, there are situations where a claim could satisfy one condition and not the other. Figure A shows the differences between these two definitions for the 1995 table set. In most states, the differences are not significant.

Figure A: Differences in User Counts between Table 7 and Table S4

Reasonability Analysis
As noted earlier, statistics presented in these tables have been developed from Medicaid SMRF data and have not been validated. However, they were reviewed for basic reasonableness, using a cross-state review process. Selected columns from selected tables for each state were combined together to allow review of the same statistics across states. While users always should be aware of anomalies resulting from small cell sizes, other discrepancies also are noted below.

Table S1:
The results appeared to be reasonable across states.

Table S2:
Only seven states of the ten have identifiable detox services: Alabama, Georgia, Kentucky, New Hampshire, New Jersey, Vermont and Wyoming. These are the only states that were used to create the "All State" table.

Table S3:
For institutional psychiatric services there are some wide variations between states. The total days range from 19.7 days in Wyoming to 132.6 days in New Jersey with the average across all states being 61.6. The lower range is the more common; with Kansas (104.7) and New Jersey being much higher. The variation may also relate to the way the services are defined by the State.

See notes under Table 5 in main document for discussion about lack of ICF/MR service use in the MH/SA population in New Hampshire, Vermont and Wyoming.

Table S4:
See notes under Table 5 in main document.

Table S5:
The results appeared to be reasonable across states.

Table S6:
The results appeared to be reasonable across states.

Table S7:
The results appeared to be reasonable across states.