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FAQ Data Descriptions Exclusions 

Select the Frequently Asked Question to view answer.
  1. What recipient populations are excluded from the data sets?
    Please see FAQ Data Description Waiver Item 7.
  2. Are there any providers excluded from the data sets?
    No. However, the only providers who are eligible for inclusion are receiving payments from Medicaid by providing services to recipients of full benefits. Providers who do not serve these recipients are not included. The number of providers in the Provider table and the Type of Service data for each provider are dependent upon the population the data user organization selects to be in the Recipient table.
  3. What data is not included in the data set?
    Exclusions include recipient demographic information on immigration status, languages spoken, prison records, and home address. Geographic exclusions are largely confined to a lack of updated, fact-checked, and cleaned zip code and county data. Additionally, data specific to a city, town, or township cannot be requested; compiling the zip codes that comprise a population center is possible, however, and we encourage data users to compile zip code groupings however is most useful to them. Eligibility does not include information on persons who are entitled to benefits but not enrolled; partial-benefits patients; and those who have been removed from the Medicaid rolls due to incarceration. Exclusions within the diagnostic set include limited information on health conditions such as obesity, dental needs, and social factors influencing health needs.

    Provider-level data is likewise incomplete. We cannot provide all addresses at which a given provider operates; rather, we substitute a primary provider address, which may be outdated or inaccurate. Likewise, we do not have complete National Provider Identifier (NPI) records, as some providers (such as personal attendants and small transportation companies) not entitled to an NPI under licensing law. For this reason, we provide randomized Key IDs where needed, with the caveat that these are not useful with respect to outside the data sets. Finally, we cannot provide information as to the quality of a particular provider.
  4. Is housing status described in the data set?
    No data on the housing status of recipient is recorded. Some subtle exceptions exist with regard to institutionalized and waiver populations, who receive services that imply their housing location. Flags for inadequately housed or homeless populations are not in the data sets, and information on Community Integrated Living Area (CILA) is also not included.
  5. How are imprisoned and post-prison populations included in the data sets?
    There are a very small number of people in prison who can receive full Medicaid benefits. These individuals are included in the data set. Incarcerated individuals who are partially eligible or who have lost eligibility due to their imprisonment are not included in the data set. Flags for previous imprisonments are also excluded from the data sets.
  6. How are quality measures and measures of recipient and provider satisfaction included in the data sets?
    No quality measures (Healthcare Effectiveness Data and Information Set (HEDIS) or otherwise) are in the data sets. No data on recipients’, providers’, or any other persons’ subjective impressions of the quality of Medicaid, other health insurance programs, or clinical care are included in the data set.
  7. Do the data sets include Prioritization of Urgency of Need for Services (PUNS) data?

    Prioritization of Urgency of Need for Services (PUNS) is a waiting list for services to persons with Developmental Disability, managed by the Illinois Department of Human Services (DHS) Division of Developmental Disabilities.

    The current data sets do not include this information. The data release that has been developed from Healthcare and Family Services (HFS) enrollment and claims data, is not linked to the DHS-managed PUNS system, and therefore does not contain PUNS data.

  8. Do the data sets include ROCS service data?

    The Community Reporting System (identified by the acronym ROCS) is a system of reporting claims data for community mental health services. The Department of Human Services (DHS) uses this system to monitor grants to service providers.

    ROCS data is not linked to the Healthcare and Family Services (HFS) data release. However, identifiable mental health claims appear in HFS claims data. Such claims appear in the following Types of Service: Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC) Mental Health Services, Inpatient Hospital: Psych, Mental Health Facility Services - Regular Payments, and Rehabilitative Services - Mental Health.

    People with mental health issues, irrespective of whether they have received DHS services, can also be identified by the Chronic Illness and Disability Payment System (CDPS) diagnostic indicators ‘Psychiatric’ (including all diagnoses except Substance Use Disorders) and ‘Substance Use Disorders’ (including all chemical dependencies and substance abuse problems).