This variable is contained in the following files:
SAS Name
MDCD_TOTAL_NON_CAPTD_SPEND
This variable is the sum of Medicaid payment amount from other services (OT) (header) claims for the beneficiary during the year, after removing the Medicaid managed care capitated payments. Note that this dollar amount may be an undercount if the beneficiary had managed care claims.
CCW calculates this variable as the sum of all MDCD_PD_AMT from the OT header claims; the exception is that CCW removed the OT claims header records for capitated payments. Capitated payments are header claims where the claim type code (T-MSIS variable called CLM_TYPE_CD) is equal to '2' (Medicaid or expansion claim) 'B' (S-CHIP claim) or 'V' (Other Services claim). These capitated payment claims are captured in MMLEADS in the MDCD_OT_MC_CAPTD_SPEND variable.
Note that the Center for Medicaid and CHIP Services (CMCS) at CMS has required redaction of the MDCD_PD_AMT field for managed care claims due to the proprietary and confidential nature of this information. Therefore, this total does not reflect the redacted managed care expenditures. MMLEADS counts all claims in the MDCD_TOTAL_USE variable. Use caution when calculating average spend per claim. There may be claims (i.e., use) for which there is no corresponding payment information.
Values: $
Source: T-MSIS Claims files (derived)