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Frequently Asked Questions

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 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.

FAQ Library

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Both the State Medicaid Director Letter describing the Substance Use Disorder (SUD) section 1115 demonstration opportunity and the Centers for Medicare & Medicaid Services (CMS) SUD Implementation Plan template, reference needs assessment tools and program standards established by the American Society for Addiction Medicine (ASAM). Is a state required to reference or rely on the ASAM Criteria in implementing an SUD section 1115 demonstration?

No, a state is not required to reference or rely on the ASAM Criteria however, states should use guidelines/patient placement tools that are comparable to ASAM criteria. The State Medicaid Director Letter describing the SUD section 1115 demonstration opportunity references the ASAM Criteria as a recognized standard and an example of a patient placement assessment tool that states could use. Participating states are expected to ensure that providers use an SUD-specific, multi-dimensional assessment tool in determining the types of treatments and level of care a beneficiary with an SUD may need. The ASAM Criteria is referenced as a representative example of such an assessment tool. 

Some states proposed alternative needs assessment tools. CMS reviews each alternative proposal on an individual basis, and CMS has so far determined that those alternatives are comparable to the ASAM Criteria and meet the expectations for this demonstration initiative. In addition, participating states are expected to implement provider qualifications for residential treatment providers that reflect well-established standards for these treatment settings. Again, the ASAM Criteria is referenced as an example of a resource that states may use for determining those standards.

FAQ ID:93681

What 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

Why 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

Why 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

Why 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.

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FAQ ID:91831

Is 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

Does 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

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

Column Name Column Description
Utilization Type

Constant “FFSU” or “MCOU”. The FFSU Record ID indicates that the information for this National Drug Code (NDC) represents a Fee-For-Service (FFS) Utilization record. The MCOU Record ID indicates that the information for this NDC represents a Managed Care Organization (MCO) Utilization record. Valid Values: 4Q2009 and earlier = Constant record ID of FFSU.1Q2010 and beyond = FFSU & MCOU. NOTE: Per the Affordable Care Act, MCO utilization data cannot be reported for periods prior to 1Q2010.

(Formerly known as "Record ID.")

State

Two-character post office abbreviation for State. Note: For any data where NDCs are aggregated (e.g. National Totals) the state code is “XX” to represent multiple states.

(Formerly known as "State Code")

Labeller Code First segment of NDC that identifies the manufacturer, labeler, relabeler, packager, repackager or distributor of the drug.
Product Code Second segment of NDC.
Package Size Code Third segment of NDC.
Year Formerly "Period Covered" and was combined with Quarter "YYYYQ"
Quarter

Valid values are:

1 = January 1 – March 31

2 = April 1 – June 30

3 = July 1 – September 30

4 = October 1 – December 31

(Formerly "Period Covered". and was combined with Year "YYYYQ")

Note: For FFS units, the Quarter/Year represents when the 11-digit NDC was paid for by the state.

For MCO units -

  • 2Q2017 and earlier, the Quarter/Year may either represent when the 11-digit NDC was dispensed, or when it was paid for by the state
  • 3Q2017 and thereafter, the Quarter/Year represents when the 11-digit NDC was dispensed.

(formerly “Period Covered”)

Product Name First 10 characters of product name as approved by the Food and Drug Administration (FDA). (formerly “Product FDA List Name”)
Suppression Used The state drug utilization data includes state, drug name, NDC, number of prescriptions, and dollars reimbursed. 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-groups are suppressed.
Units Reimbursed FFS Units - The number of units (based on Unit Type) of the drug 11-digit NDC reimbursed by the state during the quarter/year covered. MCO Units - The number of units (based on Unit Type) of the 11-digit NDC dispensed during the quarter/year covered.
Number of Prescriptions The number of prescriptions should include any prescription for which Medicaid paid a portion of the claim, as well as those prescriptions for which Medicaid paid the claim in full.
FFS - The number of prescriptions reimbursed by the state Medicaid agency as outpatient drug claims during the quarter/year covered. MCO - The number of prescriptions dispensed as outpatient drug claims during the quarter/year covered.
Total Amount Reimbursed The FFS or MCO total amount reimbursed by both Medicaid and non-Medicaid entities to pharmacies or other providers for the 11-digit NDC drug in the period covered (two previous fields added together). This total is not reduced or affected by Medicaid rebates paid to the state. This amount represents both federal and state reimbursement and is inclusive of dispensing fees. Note: As capitated payment arrangements are sometimes utilized by states and MCOs, a zero value in this field could be appropriate for MCO data; however, FFS utilization records will reject if this field is reported with a value of zero.
Medicaid Amount Reimbursed The amount reimbursed by the Medicaid Program ONLY to pharmacies or other providers for the 11-digit NDC FFS or MCO drug in the quarter/year covered. This total is not reduced or affected by Medicaid rebates paid to the state. This amount represents both federal and state reimbursement and is inclusive of dispensing fees. Note: As capitated payment arrangements are sometimes utilized by states and MCOs, a zero value in this field could be appropriate for MCO data; however, FFS utilization records will reject if this field is reported with a value of zero.
Non-Medicaid Amount Reimbursed The amount reimbursed by non-Medicaid entities to pharmacies or other providers for the 11-digit NDC FFS or MCO drug in the quarter/year covered. The Non-Medicaid Amount Reimbursed includes any drug reimbursement amount for which the state is not eligible for federal matching funds.
Quarter Begin Beginning date for quarter. Derived field provides ability to create comparisons over time. Can be used as a label for timelines.
Qarter Begin Date Beginning date for quarter. Derived field provides ability to create comparisons over time. Also can be used to create timeline visualizations
Latitude Location within state. Derived from state code provides ability to create maps and geographic comparisons.
Longitude Location within state. Derived from state code provides ability to create maps and geographic comparisons.
Location Location within state. Derived from state code provides ability to create maps and geographic comparisons.
NDC The National Drug Code (NDC) is a numerical code maintained by the FDA that includes the labeler code, product code, and package code. The NDC is an 11-digit code.

See Also:

FAQ ID:91956

What fields changed when CMS moved the State Drug Utilization Data (SDUD) to data.medicaid.gov?

As State Drug Utilization Data (SDUD) have migrated from text files to Data.Medicaid.gov, the following field names have changed:

Previous Field Name Field Name on data.medicaid.gov
Record ID Utilization Type
State Code State
Period Covered Quarter/Year
Product FDA List Name Product Name

See Also:

FAQ ID:91966

What fields were added when CMS moved State Drug Utilization Data (SDUD) to data.medicaid.gov?

As State Drug Utilization Data (SDUD) have migrated from text files to Data.Medicaid.gov, the following fields were added:

Field Purpose
Quarter Begin Can be used as a label for timelines
Quarter Begin Date Allows you to create timeline visualizations
Longitude Provides the ability to create maps and geographic comparisons
Latitude Provides the ability to create maps and geographic comparisons
Location Provides the ability to create maps and geographic comparisons

See Also:

FAQ ID:91971

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