SAMHSA Fee-For-Service Spending Estimates, Medicare- Medicaid Enrollee Analysis, and Managed Care Summary
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Analyses of MAX Claims: SAMHSA Fee-for-Service Spending Estimates, Medicare- Medicaid Enrollee Analysis, and Managed Care Summary Behavioral Health is Essential To Health • Prevention Works • Treatment is Effective • People Recover Analyses of MAX Claims: SAMHSA Fee-for- Service Spending Estimates, Medicare- Medicaid Enrollee Analysis, and Managed Care Summary U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Mental Health Services Center for Substance Abuse Treatment ii Acknowledgements This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) by Truven Health Analytics Inc. under Contract #HHSS283200700029I with SAMHSA, U.S. Department of Health and Human Services (HHS). Contracting office representatives are Christa Hrynyshen-Trimmer and Tim Mayo. Disclaimer The views, opinions, and content of this publication are those of the author and do not necessarily reflect the views, opinions, or policies of the Substance Abuse and Mental Health Services Administration (SAMHSA) or the Department of Health and Human Services (HHS). The listing of nonfederal resources is not all-inclusive, and that inclusion on the listing does not constitute endorsement by SAMHSA or HHS. Public Domain Notice All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authority of the Office of Communications, SAMHSA, HHS. Electronic Access This publication may be downloaded at http://store.samhsa.gov. Or call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español). Recommended Citation Substance Abuse and Mental Health Services Administration, Analyses of MAX Claims: SAMHSA Fee-for- Service Spending Estimates, Medicare-Medicaid Enrollee Analysis, and Managed Care Summary. HHS Publication No. (SMA) SMA-15-4908. Rockville, MD: Substance Abuse and Mental Health Services Administration (2015). Originating Office Office of Policy, Planning and Innovation, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20850. HHS Publication No. (SMA) 15-4908. 2015 HHS Publication No. SMA-15-4908. Printed in 2015 iii Contents Acknowledgements .................................................................................................................... iii Disclaimer .................................................................................................................................. iii Public Domain Notice ................................................................................................................ iii Electronic Access ....................................................................................................................... iii Recommended Citation .............................................................................................................. iii Originating Office ...................................................................................................................... iii Overview and Objectives ................................................................................................................ 1 Section 1: Fee-for-Service Medicaid Tabulations of MAX Claims Data ...................................... 3 1.1 Methods ................................................................................................................................ 3 Data .......................................................................................................................................... 3 Managed Care Spending and Enrollment ................................................................................ 3 Claims for Services .................................................................................................................. 4 Claims for Prescriptions .......................................................................................................... 7 1.2 Results ................................................................................................................................... 8 Summary of Managed Care Spending and Enrollment ........................................................... 8 Fee-for-Service Medicaid Spending ........................................................................................ 9 1.3 Limitations ......................................................................................................................... 11 1.4 Summary ............................................................................................................................ 12 Table 1. Summary of Medicaid Payments to Managed Care and Managed Care Enrollment, by State, 2008 ............................................................................................................................ 13 Table 2. Medicaid Mental Health and Substance Use Services by Provider Type: Fee-for- Service Claims, Users, and Payments for All Users, 2008 ....................................................... 16 Table 3. Medicaid Services and Products for Treatment of Mental Health and Substance Use Disorders: Fee-for-Service Claims, Users, and Payments for All Users, by State, 2008 ........ 19 Table 4. Medicaid Prescription Drugs for Treatment of Mental Health and Substance Use Disorders by Diagnosis and Therapeutic Class: Fee-for-Service Claims, Users, and Payments for All Users, 2008 .................................................................................................................... 22 Table 5. Medicaid Prescription Drugs for Treatment of Mental Health and Substance Use Disorders: Fee-for-Service Claims, Users, and Payments for All Users, by State, 2008 ........ 23 iv Section 2: Analysis of Fee-for-Service Spending on Medicare-Medicaid Enrollees .................. 26 2.1 Objectives ........................................................................................................................... 27 2.2 Methods .............................................................................................................................. 28 2.3 Results ................................................................................................................................ 29 2.4 Limitations ......................................................................................................................... 32 2.5 Summary ............................................................................................................................ 32 Table 6. Number of Medicare-Medicaid Enrollees and Non-Medicare-Medicaid Enrollees in Fee-for-Service, Comprehensive Managed Care, and Prepaid Behavioral Health Plans .. Error! Bookmark not defined. Table 7a. Total Fee-for-Service Health Care Spending per Enrollee for Medicare-Medicaid Enrollees and Non-Medicare-Medicaid Enrollees .................................................................... 37 Table 7b. Fee-for-Service Health Care Spending on Behavioral Health (MH and SA) Disorders per Enrollee for Medicare-Medicaid Enrollees and Non-Medicare-Medicaid Enrollees .................................................................................................................................... 40 Table 7c. Fee-for-Service Health Care Spending on Mental Health Issues per Enrollee for Medicare-Medicaid Enrollees and Non-Medicare-Medicaid Enrollees .................................... 43 Table 7d. Fee-for-Service Health Care Spending on Substance Use (AA and DA) Disorders per Enrollee for Medicare-Medicaid Enrollees and Non-Medicare-Medicaid Enrollees ......... 46 Table 8. Percentage of Total Medicaid Fee-for-Service Spending on Behavioral Health Conditions for Medicare-Medicaid Enrollees and Non-Medicare-Medicaid Enrollees ........... 49 Table 9. Percentage of Fee-for-Service Behavioral Health Spending on Medicare-Medicaid Enrollees .................................................................................................................................... 52 Table 10a. Fee-for-Service Spending by Provider on Total Health Care for Medicare- Medicaid Enrollees and Non-Medicare-Medicaid Enrollees .................................................... 55 Table 10b. Fee-for-Service Spending by Provider on Behavioral Health Care for Medicare- Medicaid Enrollees and Non-Medicare-Medicaid Enrollees .................................................... 56 Table 10c. Fee-for-Service Spending by Provider on Mental Health Care for Medicare- Medicaid Enrollees and Non-Medicare-Medicaid Enrollees .................................................... 57 Table 10d. Fee-for-Service Spending by Provider on Substance Use Treatment for Medicare- Medicaid Enrollees and Non-Medicare-Medicaid Enrollees .................................................... 58 Table 10e. Fee-for-Service Spending on Prescription Medications for Medicare-Medicaid Enrollees and Non-Medicare-Medicaid Enrollees .................................................................... 59 Figure 1. Distribution of Medicaid Spending on General Health for Medicare-Medicaid Enrollees and Non-Medicare-Medicaid Enrollees .................................................................... 60 v Figure 2. Distribution of Medicaid Spending on Behavioral Health for Medicare-Medicaid Enrollees and Non-Medicare-Medicaid Enrollees ...................................................................