Frequently Asked Questions

Dental services are not covered under Medicare, which means the state may not compare Medicaid rates for comparable dental services for the Medicare Equivalent of the ACR. The state may calculate a dental ACR in order to make supplemental payments to dental services providers and continue to calculate the Medicare Equivalent of the ACR for other services covered by Medicare. The state should submit two separate ACR demonstrations, one for dental services and one for physician (non-dental) services. This will involve completing two versions of the Office of Management and Budget-approved template. If the same provider provides both physician and dental services the state would differentiate the provider information between the two demonstrations by appending the Medicare Certification Number (Medicare ID) (variable 112) with a letter, such as an -A or a -B. For example, if the Medicare ID was 123456, it would be depicted in the physician ACR as 123456-A and in the dental ACR as 12345-B. If a Medicare Certification Number is not available then the state should append the Medicaid Provider Number.

FAQ ID:92441

Yes, the templates allow the use of multiple methodologies. The state would complete the templates associated with the UPL methodologies used. For example, if the state uses a cost-based methodology for state owned hospitals and a payment-based methodology for private hospitals, then the state would complete the cost template for the state owned hospitals and the payment template for the private hospitals. When using multiple methodologies, the state should insert a new tab in the templates that summarizes the UPL gap calculations for each of the ownership categories (state government owned, non-state government owned, and private), unless a summary worksheet is already included in the workbook.

FAQ ID:92271

Yes, states may use UPL methodologies that are different from their payment methodologies. For example, a state may pay for inpatient hospital services using a Medicaid APR-DRG methodology, but use a cost methodology to compute the Medicare upper payment limit for its UPL demonstration.

FAQ ID:92386

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

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

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:

• What are the data field descriptions for the State Drug Utilization Data (SDUD)?

FAQ ID:91811

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

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

Amounts reimbursed by Medicaid are pre-rebate, not net of rebates.

FAQ ID:92001

"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