Substance Abuse Spending Estimates dataset identifies public and private spending related to substance abuse per provider.
Private Payments. Any payments made through private health insurance, out-of-pocket, or other private sources.
Private health insurance is represented in two pieces in the MHSA spending estimates: benefits paid by private insurance to providers of service or for prescription drugs, and the net cost of private insurance—the difference between health premiums earned and benefits incurred—that is included in the category of insurance administration. The net cost of private insurance includes costs associated with bill processing, advertising, sales commissions, other administrative costs, net additions to reserves, rate credits and dividends, premium taxes, and profits or losses, among other items. Private health insurance benefits paid through managed care plans on behalf of Medicare or Medicaid are excluded.
Out-of-pocket payments include direct spending by consumers for health care goods and services, including coinsurance, deductibles, and any amounts paid for health care services that are not covered by public or private insurance. Health insurance premiums paid by individuals are not covered here, but are counted as part of private health insurance.
Other private includes spending from philanthropic and foundation sources and from nonpatient revenues. Nonpatient revenues are monies received for nonhealth purposes, such as from the operation of gift shops, parking lots, cafeterias, and educational programs, or from returns on investments.
Public Payments. Any payments made on behalf of enrollees in Medicare or Medicaid or through other programs run by the federal or individual state government agencies.
Medicare is a federal government program that provides health insurance coverage to eligible elderly and disabled persons. It is composed of four parts: Part A—coverage of institutional services, including inpatient hospital services, nursing home care, initial home health visits, and hospice care; Part B—coverage for physicians and other professional services, outpatient clinic or hospital services, laboratory services, rehabilitation therapy, and home health visits not covered by Part A, among other services; Part C—Medicare Advantage program providing coverage through private plans; and Part D—coverage for prescription drugs, starting in 2006.
Medicare payments include payments made through fee-for-service (Part A and Part B) and managed care (Part C and Part D) plans.
Medicaid is a program jointly funded by the federal and state governments that provides health care coverage to certain classes of persons with limited income and resources. Within federal guidelines, state governments set eligibility standards, determine services provided, set reimbursement rates, and administer the program. Income and resources are only two factors in determining eligibility, so not all poor people in a state are necessarily covered by this program. Spending represents both federal and state portions unless otherwise specified. Medicaid payments also include payments made through fee-for-service and managed care plans. This line also includes State Children’s Insurance Program (SCHIP) spending that is administered as part of the Medicaid program.
Other federal includes spending provided through the DVA and DoD, treatment spending through MH and SA block grants administered by SAMHSA, and treatment under the Indian Health Service, among other federal payers. It also includes any federal SCHIP spending that is administered separately from the Medicaid program.
Other state and local includes programs funded primarily through state and local offices of MH and SA, but may also include funding from other state and local sources such as general assistance or state and local hospital subsidies. It also includes any state and local SCHIP spending that is administered separately from the Medicaid program.