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
When a state pays a provider at reconciled cost using Certified Public Expenditures during the period covered by the Upper Payment Limit (UPL) demonstration, how should the provider's data be treated?
The UPL limits payment to the Medicare rate or cost. Providers paid at reconciled cost may receive no more than their reconciled amount. As a result, states cannot attribute the “UPL room” from other providers to pay additional amounts to any provider paid at reconciled cost. Due to this payment limitation, states should not include any provider paid at reconciled cost in their UPL demonstrations; however, they must account for these providers. Specifically, states must include with their UPL submissions documentation of those providers paid at reconciled cost and confirm by provider use of either a Medicare cost report or Centers for Medicare & Medicaid Services-approved cost report template to identify allowed cost. Further, states must document the ownership status (state owned, non-state government owned, or private) of each provider.
FAQ ID:92436
SHARE URLWhen a state pays a provider at cost during the period covered by the Upper Payment Limit (UPL) demonstration, how should the provider's data be treated?
The UPL limits payment to the Medicare rate or cost. Providers paid at cost may receive no more than their reconciled amount. As a result, states cannot attribute the "UPL room" from other providers to pay additional amounts to any provider paid at cost. Due to this payment limitation, states should not include any provider paid at cost in their UPL demonstrations; however, they must account for these providers. Specifically, states must include with their UPL submissions documentation of those providers paid at cost and, therefore, excluded from the calculation of the UPL.
FAQ ID:92396
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 URLIs the amount reimbursed by Medicaid net of rebates or pre-rebate in the State Drug Utilization Data (SDUD)?
Does the State Drug Utilization Data (SDUD) field "Units Reimbursed" represent the number of pills Medicaid paid for a drug that comes in a pill form?
"Units Reimbursed" are the number of units (based on Unit Type) of the drug (11-digit NDC level) reimbursed by the state or, for MCO drugs, the number of units dispensed during the Quarter/Year. For more specific information, you may contact either the Drug Manufacturer or State via the contact lists.
FAQ ID:92016
SHARE URLWhen are states required to submit State Drug Utilization Data (SDUD) to the Centers for Medicare & Medicaid (CMS)?
States are required to submit their utilization data to CMS within 60 days of the end of the rebate period.
FAQ ID:92026
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