. 2013 Mar 28;3(1):mmrr.003.01.b01. doi: 10.5600/mmrr.003.01.b01

Exhibit 3. Summary of the 2008 MAX Encounter OT Claims.

	State Has Comprehensive Managed Care (CMC)^a	Percentage of CMC Enrollees Met Threshold^b				State Submitted OT Encounter Claims^c				OT Encounter Records Are Complete^d				OT Encounter Records Are of Comparable Quality to FFS Data^e				OT Encounter Data Are Usable for Research^f
		A	C	D	E	A	C	D	E	A	C	D	E	A	C	D	E	A	C	D	E
Alabama
Alaska
Arizona	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Arkansas
California	X	X	X	X	X	X	X	X	X	X	X		X	X	X	X		X	X
Colorado	X	X	X	X	X	X	X	X	X			X			X	X	X			X
Connecticut
Delaware	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
DC	X	X	X	X
Florida	X	X	X	X	X	X	X	X	X	X			X	X	X	X	X	X			X
Georgia	X	X	X			X	X			X	X			X	X			X	X
Hawaii	X	X	X	X		X	X	X		X	X	X		X	X	X		X	X	X
Idaho
Illinois	X		X				X				X				X				X
Indiana	X	X	X	X		X	X	X		X	X	X		X	X	X		X	X	X
Iowa	X
Kansas	X	X	X			X	X			X	X			X	X			X	X
Kentucky	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Louisiana
Maine
Maryland	X	X	X	X		X	X	X		X	X	X
Massachusetts	X	X	X	X
Michigan	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Minnesota	X	X	X	X	X	X	X	X	X	X	X		X	X	X	X	X	X	X		X
Mississippi
Missouri	X	X	X			X	X			X	X			X	X			X	X
Montana
Nebraska	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Nevada	X	X	X
New Hampshire
New Jersey	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
New Mexico	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
New York	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
North Carolina
North Dakota
Ohio	X	X	X	X	X
Oklahoma
Oregon	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Pennsylvania	X	X	X	X	X
Rhode Island	X	X	X	X		X	X	X		X	X			X	X	X		X	X
South Carolina	X	X	X	X
South Dakota
Tennessee	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Texas	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Utah
Vermont	X
Virginia	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Washington	X	X	X
West Virginia	X	X	X
Wisconsin	X	X	X			X	X			X	X				X				X
Wyoming
Total	35	32	33	25	18	24	25	20	16	23	23	16	15	21	24	19	15	21	22	15	14

NOTE. A=Adults, C=Children, D=Disabled, E=Aged.

At least one percent of enrollees participated in HMO/HIO at some point during 2008.

At least 10 percent of enrollees in the BOE participated in HMO/HIO at some point during the year.

In addition to having at least 10 percent HMO/HIO participation, the state submitted at least 200 encounter claims for the BOE.

The BOE-specific metric was met for at least one of the two completeness measures: (1) percentage of enrollees with OT encounter claims (TOS = 08, 11, 12) and (2) average number of OT encounter claims per enrollee.

The BOE-specific metric was met for at least four of the five quality measures: (1) percentage of OT claims with place of service, (2) percentage of OT claims with a primary diagnosis code, (3) percentage of claims with a primary diagnosis code with a character length greater than 3, (4) percentage of claims with a procedure (service) code, and (5) percentage of claims with a procedure code in CPT-4 or HCPCS format.

Both the completeness and quality standards were met for the BOE.

SOURCE: Mathematica's analysis of the MAX 2008 PS and OT files.