Diagnostic information is included in Data Set I in the form of Chronic Illness and Disability Payment System (CDPS) classifications. CDPS is a diagnosis-based risk adjustment method that compiles ICD-9 codes, augmented in a limited number of cases by National Drug Codes (NDCs), into 20 categories based on a specific body system (for example, the cardiovascular system) or a highly prevalent, complex disease (such as HIV/AIDS). Within a category, CDPS provides a hierarchy of health needs ranging from “super low” to “extra high.”
While CDPS data can be used to predict expenditures, Healthcare and Family Services (HFS) is releasing CDPS data with the intention that partners will complete epidemiological analyses for inclusion in proposals. Risk adjustment for cost neutrality and shared savings calculations may or may not be based on CDPS hierarchies. For more information on CDPS, please see our CDPS documentation.
We welcome the addition of auxiliary data sources addressing epidemiological aspects of the populations our prospective partner organizations wish to serve. Please provide full references for all included data.
The Solicitation incorporates the term “Serious Mental Illness (SMI),” which refers to persons with the disorders listed in the table below. This list is derived from 89 Illinois Administration Code Part 145.10.
SMI disorders do not cleanly overlap any severity level within the Chronic Illness and Disability Payment System (CDPS) system. Rather, the disorders listed in the Serious Mental Illness definition fall within five distinct levels of healthcare service use within CDPS, ranging from “high” to “super low.”
To allow partners to analyze data specific to the SMI category, we have added an indicator to the data sets. In addition, partner organizations can examine CDPS data on psychiatric diagnoses at multiple levels of severity, and can choose to analyze a CDPS severity level that most closely matches a population of interest.
Proposal documents should include accurate descriptions of the populations that an entity wishes to serve, including references to CDPS classifications and the SMI definition as needed.
Substance Use Disorders (SUDs) are a defined category within the data sets’ Chronic Illness and Disability Payment System (CDPS) diagnostic system information and in the Care Cordination Innovations Project (CCIP) data sets’ Types of Service data. This diagnostic category includes but is not limited to drug dependence, alcohol dependence, substance misuse, and alcohol- and drug-induced mental disorders.
While the ICD-9 classifies Substance Use Disorders (SUDs) as a subset of Psychiatric disorders, the CDPS diagnostic system separates them as a distinct category. This permits data users to analyze mental illness and substance use disorder co-morbidities (also known as ‘dual diagnosis,’ or ‘MISA’ diagnoses). Approximately half of the recipients with SUD diagnoses at the CDPS levels “low” and “very low” have a concurrent Serious Mental Illness (SMI) indicator.
This category of diagnoses is also connected with a specific subset of Types of Services. These include Inpatient Hospital-Substance Abuse and Rehabilitative Services-Substance Abuse. Recipients may be treated for SUDs in the course of other treatment as well (in this case, no Type of Service might directly describe their SUD diagnosis). We find that Types of Services for SUD map well to CDPS levels “low” and “very low” (SUDL and SUDVL). They do not map well to the CDPS level “Not Well Defined” under SUD. “Not Well Defined” SUD diagnoses include cigarette smoking, marijuana use, substance abuse not elsewhere classified, and other miscellaneous diagnoses. We recommend that SUD-diagnosed recipients be identified using the CDPS “low” and “very low” levels of severity within the SUD category.
Informally, this term or some diagnostic codes associated with the term may be substituted with ‘substance abuse,’ ‘addiction,’ ‘chemical dependency,’ and a wide variety of other terms. Therefore, proposals analyzing SUD-related data and/or describing target population needs should clarify the intended meaning of this term or any near-synonyms that they use in their proposals.
For more information, please see our CDPS documentation.
Developmental Disability can be identified via the Chronic Illness and Disability Payment System (CDPS) diagnostic indicator ‘Developmental Disability.’ For more information on diagnostic indicators, please see our CDPS documentation.
Those individuals who are recipients of Developmental Disability-related Home and Community Based Services (HCBS) waivers may also submit claims for many HCBS waiver Types of Services. Individuals may receive the Children’s Residential DD Waiver and/or the Children’s Supportive DD Waiver (for persons aged 3 to 21) or the Adult DD Waiver (age 19 and up). They may receive Types of Service that include Adult Day Health, Case Management, Day Habilitation, Residential Habilitation, Supported Employment, and Extended State Plan Services.
Developmental Disability can also be identified via the Types of Service ‘Intermediate Care Facility – Public Provider’ and ‘Intermediate Care Facility – Private Provider.’ These Types of Service are not related to Home- and Community-Based Services waivers.