This variable is contained in the following files:
SAS Name
MDCD_OT_TOTAL_SPEND
This variable is the sum of Medicaid payment amount from the other services (OT) (header) claims for the beneficiary during the year, after removing the managed care capitated payments. Note that this dollar amount may be an undercount if the beneficiary had managed care claims.
CCW filtered the OT claims header records to distinguish between capitated payments and payments for services. 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 not included in this variable; they are captured in MMLEADS in the MDCD_OT_MC_CAPTD_SPEND variable.
CCW calculates this variable as the sum of all MDCD_PD_AMT from the non-capitated payment Other Services (header) claims. The Center for Medicaid and CHIP Services (CMCS) at CMS has required redaction of this payment field for managed care claims due to the proprietary and confidential nature of this information. Therefore, when summing Medicaid expenditures using the claim files it is important to keep in mind that totals will not reflect the redacted managed care expenditures.
MMLEADS counts all claims in the MDCD_OT_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 Other Services Claims file (derived)