Frequently Asked Questions are used to provide additional information and/or statutory guidance not found in State Medicaid Director Letters, State Health Official Letters, or CMCS Informational Bulletins. The different sets of FAQs as originally released can be accessed below.
Frequently Asked Questions
How will states with Medicaid managed care programs comply with the requirement to report provider participation levels specified in 42 CFR 447.400(d)(1)?
At this time, the Center for Medicare & Medicaid Services (CMS) is not defining the form of information required under 42 CFR 447.400(d)(1), but we do suggest that states with Medicaid managed care programs conduct a baseline assessment of primary care access before the provision goes into effect. This baseline assessment will ensure that Congress, CMS, and researchers have comparative data to evaluate this provision.
Supplemental Links:
FAQ ID:91426
SHARE URLWhat Dataset Views are available for the State Drug Utilization Data (SDUD)?
Per the state drug utilization data table, the "Dataset Views" dropdown selections available are:
- State: State-specific data at the NDC-11 level, for a quarter/year.
- Full Dataset (States + National Totals): A compilation of all the individual state utilization data (50 states plus Washington D.C.) and the National Totals at the NDC-11 level, for a selected year.
- All States: Includes data for all states but does not include the National Totals
- National Totals: Data are aggregated for all 50 states and Washington, D.C. at the NDC-11 level, for a quarter/year.
Since all of the states are combined in the National Totals, the state abbreviation will show on the "Annual State Detail" with a state abbreviation of "XX".
Users can also generate his or her own views of the dataset on data.medicaid.gov.
FAQ ID:91786
SHARE URLWhy am I unable to see all of the data in the dataset/view?
You are likely running into a limitation of the program you are trying to use to analyze the data. Microsoft Excel allows 1,048,576 rows of data and many of our datasets exceed this limit.
We recommend users not use Excel for large datasets but instead use another application that can work with datasets of large size (e.g. Microsoft Access).
FAQ ID:91801
SHARE URLWhy is there a State column labeled XX when viewed as National Totals in the State Drug Utilization Data (SDUD)?
Since all of the states are combined in the National Totals, the state abbreviation will show on the "National Totals" and "Annual State Detail" option as "XX".
See Also:
FAQ ID:91811
SHARE URLWhy does some State Drug Utilization Data (SDUD) have an asterisk?
As CMS is obligated by the Federal Privacy Act, 5 U.S.C. Section 552a and the HIPAA Privacy Rule, 45 C.F.R Parts 160 and 164, to protect the privacy of individual beneficiaries and other persons, all direct identifiers have been removed and data that are less than eleven (11) counts are suppressed. An asterisk (*) notes suppressed data. CMS applies counter or secondary suppression in cases where only one prescription is suppressed for primary reasons, e.g. one prescription in a state. Also, if one sub-group (e.g. number of prescription) is suppressed, then the other sub-group is suppressed.
See Also:
- What fields changed when CMS moved the State Drug Utilization Data (SDUD) to data.medicaid.gov?
- What are the data field descriptions for the State Drug Utilization Data (SDUD)?
- Is the redacted State Drug Utilization Data (SDUD) available to the public?
FAQ ID:91831
SHARE URLIs the redacted State Drug Utilization Data (SDUD) available to the public?
No. In accordance with federal laws, State Drug Utilization Data (SDUD) that has been suppressed is not available for public consumption. As CMS is obligated by the Federal Privacy Act, 5 U.S.C. Section 552a and the HIPAA Privacy Rule, 45 C.F.R Parts 160 and 164, to protect the privacy of individual beneficiaries and other persons, all direct identifiers have been removed and data that are less than eleven (11) counts are suppressed. A checkmark in the "Suppression Used" column notes suppressed data. CMS applies counter or secondary suppression in cases where only one prescription is suppressed for primary reasons, (e.g., one prescription in a state). Also, if one sub-group (e.g., number of prescriptions) is suppressed, then the other sub-group is suppressed.
FAQ ID:91856
SHARE URLDoes the State Drug Utilization Data (SDUD) reported for each quarter's posting always include all of the quarterly data reported by states?
If the data arrives late, it may miss the quarterly posting. However, it will be included in the next quarter's web posting.
FAQ ID:91916
SHARE URLWhat are the data field descriptions for the State Drug Utilization Data (SDUD)?
For current versions of MDRP File Formats/Data Definitions, please refer to: https://www.medicaid.gov/medicaid/prescription-drugs/medicaid-drug-rebate-program/medicaid-drug-rebate-program-mdrp-file-formats-data-definitions-and-medicaid-drug-programs-mdp-email-communications/index.html
See Also:
- What fields changed when CMS moved the State Drug Utilization Data (SDUD) to data.medicaid.gov?
- Is the redacted State Drug Utilization Data (SDUD) available to the public?
FAQ ID:91956
SHARE URLWhat is the difference between "Medicaid Amount Reimbursed" vs. "Non-Medicaid Amount Reimbursed" in the State Drug Utilization Data (SDUD)?
A Non-Medicaid Reimbursed amount is any amount paid on a claim by parties other than Medicaid (e.g., other federal coverage, co-pay, private insurance). If a state receives Federal Financial Participation (FFP) for any part of a claim for a Covered Outpatient Drug (COD), that portion of the claim is included in the Medicaid Reimbursed amount. If a state does not receive FFP for any part of a rebate-eligible claim, then the amount of the claim is included in the Non-Medicaid Reimbursed amount.
FAQ ID:91981
SHARE URLWhy Does the "Medicaid Amount Reimbursed" and the "Non-Medicaid Amount Reimbursed" not equal the "Total Amount Reimbursed" in the State Drug Utilization Data (SDUD)?
The sum of the “Medicaid Amount Reimbursed” and the “Non-Medicaid Amount Reimbursed” fields should generally equal the Total Amount Reimbursed on a National Drug Code (NDC) by NDC basis; however, these new fields were implemented beginning with the fourth quarter of 2007 and are optional for the states to report prior to that time. Therefore, for quarters earlier than fourth quarter 2007, there may be some large discrepancies between the Total Amount Reimbursed and the sum of the Medicaid Amount Reimbursed and the Non-Medicaid Amount Reimbursed because the Non-Medicaid Amount Reimbursed is often not present for those earlier quarters. Should you notice apparent discrepancies in an individual state's utilization data, your questions should be directed to the State Technical Contact.
FAQ ID:91986
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