Managed Long Term Care (MLTC) MEDS Workshop Conference

The NYSDOH, in conjunction with IPRO, sponsored a workshop addressing the Medicaid Encounter Data System (MEDS) submission process, focusing on the Managed Long Term Care product lines (partially capitated, PACE, Medicaid Advantage Plus). The conference was held at the New Yorker Hotel, NYC, on November 13, 2013.

Forty nine (49) staff members from twenty eight (28) health plans attended the conference. Among the attendees were staff members from the following newly formed MLTC plans:

  • AgeWell New York
  • Alpha Care of New York
  • AmidaCare Home Life Plus
  • Integra MLTC
  • North Shore LIJ Plan
  • Partners Health Plan
  • Prime Health Choice
  • VNA Options

Presentation staff consisted of three (3) NYSDOH representatives, 3 representatives from Computer Sciences Corporation (CSC), and 2 IPRO staff.

Workshop topics included the following:

  1. Definition /Uses of Encounter Data
  2. MEDS Resources
  3. MEDS Response Files
  4. Data Validation Reports
  5. Plan Presentation (HealthFirst´s MEDS Submission Process)

Definition/Uses of Encounter Data

The NYSDOH´s presentation included a definition of encounter data, how encounter data is used in risk rate development, and examples of problematic data. Included in this presentation were general MEDS reporting requirements, plan benefits of encounter data, and the risk rate development process (e.g. shadow pricing, acuity, cost index and weights, and risk scores).

IPRO´s presentations included a summary of the MEDS Readiness reviews conducted in 2012 and early 2013. The readiness review survey details were discussed, along with a summary of the survey findings. IPRO indicated that the need for guidance in interpreting response files and validation reports were key MEDS readiness findings.

IPRO also presented several examples of encounter data validation projects, involving encounter data from New York as well as from health plans in other states. Two (2) projects involved medical record validation, where samples of primary care encounter data were compared to medical records, for the purpose of determining under-reporting, over -reporting, or mis-coding.

Separately, IPRO presented examples of validation reports, generated from the tracking and trending of encounter data from state databases.

MEDS Resources

The NYSDOH listed the basic resources associated with MEDS data, including the MEDS III Data Element Dictionary, the MEDS Service Utilization and Reporting Guide, as well as the web sites associated with MEDS submissions.

MEDS Response Files

CSC´s presentation addressed response files generated from MEDS submissions. CSC demonstrated the eMedNY submitter dashboard, and discussed the dashboard´s use as a means to locate, research, and monitor incoming/outbound batch files. Response file types were discussed (Tier 1 edit reports, acknowledgement files, daily and monthly summary reports).

Data Validation Reports

The NYSDOH discussed the validation reports generated regularly from MEDS submissions. The report components (member months, units and unit cost, sum and total paid amounts, etc), as well as the service areas covered in the reports (Home Health Care, Other MLTC, Nursing Facility, Personal Care) were discussed.

Plan Presentation

HealthFirst´s presentation described their approach for submitting encounters, highlighting the process as it relates to the two (2) MLTC product lines. The plan´s MEDS production process (including internal filters, validation checks) was discussed. MEDS monitoring strategies (e.g. tier 1 edit monitoring, bi-weekly submissions in lieu of monthly submissions) were also discussed. Moreover, the plan provided their crosswalk of home grown codes to industry standard codes for some services in the Medicaid Advantage Plus product line.

Several plans commented favorably on the conference and its usefulness in understanding the MEDS process, especially for the newer MLTC plans.