Abstract
BackgroundIn July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations that govern network and access standards for enrollees. There have been few published studies of whether there is accurate geographic information on primary care providers to monitor network adequacy.MethodsWe analyzed a sample of nurse practitioner (NP) and physician address data registered in the state labor, licensing, and regulation (LLR) boards and the National Provider Index (NPI) using employment location data contained in the patient-centered medical home (PCMH) data file. Our main outcome measures were address discordance (%) at the clinic-level, city, ZIP code, and county spatial extent and the distance, in miles, between employment location and the LLR/NPI address on file.ResultsBased on LLR records, address information provided by NPs corresponded to their place of employment in 5% of all cases. NP address information registered in the NPI corresponded to their place of employment in 64% of all cases. Among physicians, the address information provided in the LLR and NPI corresponded to the place of employment in 64 and 72% of all instances. For NPs, the average distance between the PCMH and the LLR address was 21.5 miles. Using the NPI, the distance decreased to 7.4 miles. For physicians, the average distance between the PCMH and the LLR and NPI addresses was 7.2 and 4.3 miles.ConclusionsPublicly available data to forecast state-wide distributions of the NP workforce for MMC members may not be reliable if done using state licensure board data. Meaningful improvements to correspond with MMC policy changes require collecting and releasing information on place of employment.
Highlights
In July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations that govern network and access standards for enrollees
We examined the agreement and discordance (e.g., %) between addresses listed in the patient-centered medical home (PCMH) file against two publicly available data sources frequently used to map the nurse practitioner (NP) workforce: state licensure board (LLR) records and the national provider identifier (NPI) file
As a provider could be employed at more than one PCMH, we considered an address match to be correct if at least one of the addresses listed in the PCMH file matched the address information in the LLR or National Provider Index (NPI)
Summary
In July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations that govern network and access standards for enrollees. In July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations to ensure adequate network and access standards for enrollees for access to primary care as well as a host of specialist, hospital, and pharmacological services [1]. Medicaid recipients have consistently reported less timely access to health care services than other population groups [7,8,9]. They are a population group who more often require treatment for complex health conditions, many of which go untreated due to barriers to care access [10, 11].
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