F Appendix F_SCDTDP_Data Request Form

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Overview

01_Data Form
02_Definitions Measure Concepts
03_Logic Specifications

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Sheet 1: 01_Data Form

Appendix D: SCDTDP Data Request Form
Sickle Cell Treatment Demonstration Program
Data Request - Sample Data Form to request data from MCO or State Medicaid
Measure ID	Measure Type (Provider, Location, Zip3, Zip5, or State)	Population ID (based on measure type)	Reference Period	Reference Period Start Date (mm/dd/yyyy)	Reference Period End Date (mm/dd/yyyy)	Numerator Count	Denominator Count	System Date	Data Source
(ex. Measure 1a)	(ex. Provider)	(ex. Zip3 = 019 or State = MD)	(ex. Month-Year (10-2014) for monthly measures, Quarter-Year (Q1-2014) for Quarterly Measures)	Date when reference period begins	Date when reference period ends	(ex. # Providers from the denominator population who saw at least one patient with SCD who was less than 18 years old at the time of the visit for at least two non-emergent outpatient visits during the 12 month period ending with the reference month)	(ex. # Providers who had at least one claim submitted to the plan during the 12 month period ending with the reference month)	(Date report was run)	(ex. CMS data, Managed Care Plan data, etc.)
* See definitions of measure concepts and logic specifications on Tabs 2-3

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Sheet 2: 02_Definitions Measure Concepts

Sickle Cell Treatment Demonstration Program
NICHQ, Inc.: I added the parenthetical Medicaid (state or MCO) Data Request
Measure Concepts
Provider	NPI codes, other de-identified provider ID
Provider Location*	Provider group practice location, etc.
Patient	Monthly reporting: age as of last day of reference month
	Quarterly reporting: age as of last day of reference quarter
	Age at time of visit
	Patient filled prescription
Geographical Area	Zip codes (5 digit or 3 digit) for practice
Visit Type	Non-emergent or outpatient visit - see specifications in Tab 3
Reference Month	Monthly reports: that month
	Quarterly reports: last month of quarter
Claims	Paid claims (confirming whether states can also do pending, suspended, and/or denied)
Outcomes	Visit: outpatient, exclude ER or inpatient visits
	Medication Prescription: Filled prescriptions for Hydroxyurea
* This measure can be rolled into geographical measure

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Sheet 3: 03_Logic Specifications

Sickle Cell Treatment Demonstration Program
Medicaid (state or MCO) Data Request - Logic Specifications and Codes
Aim 1: Increase the number of providers treating persons with sickle cell disease
Measure 1a: Number of providers in Plan who saw at least one patient younger than 18 years of age with SCD two or more times during the past 12 months
Denominator Population:	Providers who had at least one claim submitted to the plan during the 12 month period ending with the reference month.
Numerator Population:	Providers from the denominator population who saw at least one patient with SCD who was less than 18 years old at the time of the visit for at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month.
Exclusions:	Patients who also have a diagnosis of sickle cell trait (Table 3) should be excluded from denominator.
Reporting Outputs:	Denominator and numerator counts and percent.
Reporting Interval:	Monthly
Comments:	Claims include those paid, suspended, pending or denied.
Measure 1b: Number of providers in Plan who saw at least one adult patient with SCD two or more times during the past 12 months
Denominator Population:	Providers who had at least one claim submitted to the plan during the 12 month period ending with the reference month.
Numerator Population:	Providers from the denominator population who saw at least one patient with SCD who was 18 years of age or older at the time of the visit for at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month.
Exclusions:	Patients who also have a diagnosis of sickle cell trait (Table 3) should be excluded from denominator.
Reporting Outputs:	Denominator and numerator counts and percent.
Reporting Interval:	Monthly
Comments:	Claims include those paid, suspended, pending or denied.
Measure 1c: Number of providers in Plan who saw any patient with SCD two or more times during the past 12 months
Denominator Population:	Providers who had at least one claim submitted to the plan during the 12 month period ending with the reference month.
Numerator Population:	Providers from the denominator population who saw any patient with SCD for at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month.
Exclusions:	Patients who also have a diagnosis of sickle cell trait (Table 3) should be excluded from denominator.
Reporting Outputs:	Denominator and numerator counts and percent.
Reporting Interval:	Monthly
Comments:	Claims include those paid, suspended, pending or denied.
Measure 1d: Percent of children in Plan with SCD who had at least 2 outpatient visits in the past 12 months.
Denominator Population:	Patients less than 18 years old as of the end of the reference month who have ever had a diagnosis of sickle cell disease (Table 1) and who had at least one health care event (any claim) during the 12 month period ending with the reference month.
Numerator Population:	Patients from the denominator population who had at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month.
Exclusions:	Patients who also have a diagnosis of sickle cell trait (Table 3) should be excluded from denominator.
Reporting Outputs:	Denominator and numerator counts and percent.
Reporting Interval:	Monthly
Comments:	Claims include those paid, suspended, pending or denied.
Measure 1e: Number of adults in Plan with SCD who had at least 2 outpatient visits in the past 12 months.
Denominator Population:	Patients who were 18 years old or older as of the end of the reference month who have ever had a diagnosis of sickle cell disease (Table 1) and who had at least one health care event (any claim) during the 12 month period ending with the reference month.
Numerator Population:	Patients from the denominator population who had at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month.
Exclusions:	Patients who also have a diagnosis of sickle cell trait (Table 3) should be excluded from denominator.
Reporting Outputs:	Denominator and numerator counts and percent.
Reporting Interval:	Monthly
Comments:	Claims include those paid, suspended, pending or denied.
Aim 2: Increase the number of providers prescribing hydroxyurea
Measure 2a: Number of providers in Plan who prescribed hydroxyurea to a child with SCD at least once during the past 12 months
Denominator Population:	Providers who submitted at least one claim to the plan during the 12 month period ending with the reference month.
Numerator Population:	Providers from the denominator population who had a patient under 18 years old and who have a diagnosis of sickle cell disease (Table 1) and who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month.
Exclusions:	Providers whose patients also have a diagnosis of sickle cell trait (Table 3) should be excluded from numerator.
Reporting Outputs:	Denominator and numerator counts and percent.
Reporting Interval:	Monthly
Comments:	Claims include those paid, suspended, pending or denied.
Measure 2b: Number of providers in Plan who prescribed hydroxyurea to an adult with SCD at least once during the past 12 months
Denominator Population:	Providers who submitted at least one claim to the plan during the 12 month period ending with the reference month.
Numerator Population:	Providers from the denominator population who had a patient over 18 years old and who have a diagnosis of sickle cell disease (Table 1) and who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month.
Exclusions:	Providers whose patients also have a diagnosis of sickle cell trait (Table 3) should be excluded from numerator.
Reporting Outputs:	Denominator and numerator counts and percent.
Reporting Interval:	Monthly
Comments:	Claims include those paid, suspended, pending or denied.
Measure 2c: Number of providers in Plan who prescribed hydroxyurea at least once during the past 12 months
Denominator Population:	Providers who submitted at least one claim to the plan during the 12 month period ending with the reference month.
Numerator Population:	Providers from the denominator population who had any patient with a diagnosis of sickle cell disease (Table 1) who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month.
Exclusions:	Providers whose patients also have a diagnosis of sickle cell trait (Table 3) should be excluded from numerator.
Reporting Outputs:	Denominator and numerator counts and percent.
Reporting Interval:	Monthly
Comments:	Claims include those paid, suspended, pending or denied.
Measure 2d: Number of children with SCD who filled a prescription for hydroxyurea at least once during the past 12 months
Denominator Population:	Patients less than 18 years old as of the end of the reference month who have ever had a diagnosis of sickle cell disease (Table 1) and who had at least one health care event (any claim) during the 12 month period ending with the reference month.
Numerator Population:	Patients from the denominator population who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month.
Exclusions:	Patients who also have a diagnosis of sickle cell trait (Table 3) should be excluded from denominator.
Reporting Outputs:	Denominator and numerator counts and percent.
Reporting Interval:	Monthly
Comments:	Claims include those paid, suspended, pending or denied.
Measure 2e:
Number of adults with SCD who filled a prescription for hydroxyurea at least once during the past 12 months
Denominator Population:	Patients 18 years of age or older as of the end of the reference month who have ever had a diagnosis of sickle cell disease (Table 1) and who had at least one health care event (any claim) during the 12 month period ending with the reference month.
Numerator Population:	Patients from the denominator population who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month.
Exclusions:	Patients who also have a diagnosis of sickle cell trait (Table 3) should be excluded from denominator.
Reporting Outputs:	Denominator and numerator counts and percent.
Reporting Interval:	Monthly
Comments:	Claims include those paid, suspended, pending or denied.
Table 1: Codes to Identify Sickle Cell Disease
Condition Name	ICD-9	ICD-10
Hb S beta‐thalassemia	282.41, 282.42	D57.40, D57.41
Hb SS‐disease (sickle cell anemia)	282.6, 282.61, 282.62	D57 Sickle cell disorders
		D57.0 Sickle cell anemia with crisis
		D57.1 Sickle cell anemia without crisis
Hb SC‐disease	282.63, 282.64	D57.20, D57.21
Hb SD‐disease	282.68, 282.69	D57.80, D57.81
Hb SE‐disease	282.68, 282.69	D57.80, D57.81
Condition Name Hemoglobin Screening Result ICD‐9 Code(s)
Table 2: Codes to Identify Outpatient Care
Description	CPT	ICD-9
Office or other outpatient services	99201‐99205, 99211‐99215, 99241‐
	99245
Preventive medicine	99381‐99385, 99391‐99395, 99401‐
	99404, 99411‐99412, 99420, 99429
General medical examination		V20.2, V70.0, V70.3,
		V70.5, V70.6, V70.8
Table 3: Excluded Sickle Cell Related Codes
Condition Name	ICD-9	ICD-10
Hb S (sickle)‐carrier (sickle cell trait)	282.5	D57.3