View Policy Brief

03/2024

There is limited information on the extent to which Rural Health Clinics (RHC) provide pediatric and pregnancy-related services to individuals enrolled in state Medicaid/CHIP programs. In part, this is because methods to identify RHC encounters within Medicaid claims data are outdated. This brief describes a methodology for identifying RHC encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.

Highlights:

• Estimates of pediatric and pregnancy-related services provided to patients enrolled in state Medicaid/CHIP programs in 20 states were analyzed using the 2018 Medicaid Demographic and Eligibility and Other Services T-MSIS Analytic Files. Researchers scanned fee-for-service and Medicaid encounter claims (and claim lines, representing unique procedures provided at each visit), looking for eight possible indicators of an RHC encounter. Researchers then categorized the percentage of RHC encounters captured by each of the eight indicators listed for one of their populations of interest: the pediatric population.
• Researchers found substantial variation in how RHC encounters were identified across states. For example, type of bill (provided on facility claims) code "071" identified the majority of RHC encounters in Maine, Montana, Nebraska, New Mexico, Oklahoma, and Wyoming, whereas place of service (provided on professional claims) code "72" identified the majority of RHC encounters in Iowa, Kansas, Kentucky, Mississippi, North Carolina, South Carolina, South Dakota, and Tennessee.
• This strategy to identify RHC encounters could be used by T-MSIS data users to identify RHC encounters. However, this methodology for identifying RHC encounters could have led to misclassification of RHC encounters (undercounting or overcounting encounters) and needs further validation.

Maine Rural Health Research Center

Katherine Ahrens, Zachariah Croll, Yvonne Jonk, John Gale, Heidi O'Connor

Children and adolescents, Health services, Medicaid and CHIP, Rural Health Clinics (RHCs), Rural statistics and demographics