New Evidence of State Variation in Medicaid Payment Policies for Dual Medicare-Medicaid Enrollees: Policy Database and Index

These data track state Medicaid programs' policies for paying Medicare's cost sharing for low-income individuals who have Medicare and Medicaid ("dual eligibles"). Our database focuses on Medicaid policies for paying the cost sharing for outpatient and physician services covered by the Medicare Part B program. We track state policies longitudinally from 2004-2018 based on information abstracted from online Medicaid policy documents, legal databases, and policy data reported to us by 22 state Medicaid programs. We also developed a Medicaid payment index, which reflects the proportion of the Medicare Part B allowed amount (i.e., price) for physician office visits that providers would expect to be paid per service provided to a dual eligible patient, in aggregate from Medicare and Medicaid, given these state policies. One version of this index reflects payments to physicians who qualified for higher Medicaid fees under the Affordable Care Act's Medicaid Fee Bump (implemented nationally from 2013-14) and one version reflects payments to physicians who were ineligible for the fee bump.<br>Download the attached Excel files to retrieve the database and additional documentation. The compressed folder 'final document library' contains the original source policy documents (in PDF format) that are catalogued in the database.<br><br>More detail about this database and our findings can be found in the article:<br>Roberts ET, Nimgaonkar A, Aarons J, Tomko H, Shartzer A, Zuckerman SB, and James AE. "New Evidence of State Variation in Medicaid Payment Policies for Low-Income Medicare Beneficiaries," <i>Health Services Research</i> 2020 (doi: 10.1111/1475-6773.13545).

本数据集追踪各州医疗补助计划（Medicaid）针对同时拥有医疗保险（Medicare）与医疗补助计划的低收入群体（即“双重资格受益人（dual eligibles）”）支付医疗保险费用分担的相关政策。本数据库聚焦于医疗保险B部分（Medicare Part B）覆盖的门诊及医师服务的医疗补助费用分担支付政策。本研究基于在线医疗补助政策文档、法律数据库以及22个州医疗补助计划提交的政策数据，对2004-2018年的各州政策进行了纵向追踪。本研究还构建了一项医疗补助支付指数，该指数反映了在当前各州政策框架下，医疗机构为每位双重资格受益人提供医师门诊服务时，可从医疗保险与医疗补助计划合计获得的、占医疗保险B部分允许金额（即定价）的支付比例。该指数包含两个版本：其一对应在《平价医疗法案》（Affordable Care Act）医疗补助费用上调（Medicaid Fee Bump，2013-2014年全国实施）政策下符合更高医疗补助收费标准的医师所获得的支付，其二对应不符合该费用上调政策资格的医师所获得的支付。
请下载附件中的Excel文件以获取本数据库及补充文档。压缩文件夹"最终文档库"包含本数据库收录的原始政策源文件（PDF格式）。

有关本数据库及本团队研究发现的详细内容可参阅以下论文：
Roberts ET、Nimgaonkar A、Aarons J、Tomko H、Shartzer A、Zuckerman SB及James AE. 《低收入医疗保险受益人的医疗补助支付政策存在州际差异的新证据》，《卫生服务研究（Health Services Research）》，2020年（doi: 10.1111/1475-6773.13545）。