Readme_PBP_Benefits_2024.txt

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CHANGE LOG:
10/01/2023  added files- pbp_step1.txt,pbp_step1_b.txt,pbp_step2.txt,pbp_step2_b.txt,pbp_step3.txt,pbp_step4.txt,pbp_step9.txt,pbp_step13.txt,pbp_step14.txt,pbp_step20.txt.	
			Two columns "Json Question" and "Service category" added to pbp dictionary.		
			PBP_B16A_BENDESC_NUMV_DX column length changed to 4 as per pbp redesign.
			pbp_b19a_states_ehc_vbd_d,pbp_b19b_states_ehc_vbd_d columns added.
			readme updates for POS/OON  
            PBP_B20_INSULIN_COINS_MIN_PCT,PBP_B20_INSULIN_COINS_MAX_PCT,PBP_B20_INSULIN_COPAY_MIN,PBP_B20_INSULIN_COPAY_MAX	
            columns added. PBP_B20_COINS_MC_EHC,PBP_B20_COPAY_MC_EHC lookup values changed.

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This zip file contains Plan Benefit Package (PBP) tab delimited text files from the HPMS 
data repository, SAS programs, and files with supporting documentation. The SAS programs 
are compatible with SAS Version 7 or above and the input and library file path names need 
to be changed to your working subdirectory.


The CY 2024 PBP Benefits file provides the universe of PBP data for all active contracts 
and contains all the approved benefit and financial data submitted as part of the CY 2024 
Bid Submission by Medicare Advantage and Part D organizations, including those involved in 
certain demonstration projects and cost plans. The PBP Benfits file is updated quarterly.

Summary of high-level changes made to the CY 2024 PBP DEF files: 

Optional supplemental cost sharing: 

•	In the old PBP, users entered optional supplemental cost sharing in Section B along with their mandatory benefits. 

•	In the new PBP, this cost sharing is entered into the optional supplemental benefit section of the module. To reflect this change, we have added files in the PBP extract to store this cost sharing.  

Authorization and referrals: 

•	In the old PBP, users entered these data at varying benefit levels.  In cases where the data were collected at a “parent” level, but the plan only required authorization or referral for part of the parent benefit, the user would be required to mark authorization and referral as required at the parent level.  

•	In the new PBP, we set up the authorization and referral questions at the same level across all benefits. To limit the number of changes to the CY 2024 PBP data extract, we are rolling up these more granular data to the prior parent benefit levels (i.e., as they were presented in the CY 2023 extracts). 

•	Please note that you can still access the “new” discrete authorization and referral data in the CY 2024 PBP data extract for all benefits with the exception of optional supplemental and VBID.  This more granular data will be stored in the authorization and referral benefit variables previously only used for standard bid but now used for all plans (see pbp_Section_A.txt).

Description values: 

•	We have added variables for “Other, describe” fields. 

Group names:  

•	We have added variables for cost share group names. 

Differential deductibles and Mandatory Supplemental deductibles  (PPOs only):  

•	In the old PBP, users entered PPO deductibles at the parent benefit level.  

•	In the new PBP, these data are collected at the more discrete benefit level.  We have added variables to account for these data.  Note: We are not populating the data at the parent benefit levels in this case. 


IRA changes:  

•	We have made changes to the PBP data extracts to reflect IRA-related changes, such as insulin-specific cost sharing. 

VBID/UF/SSBCI Reduction in Costs Packages: 

•	In the old PBP, the cost sharing (coinsurance, deductible, copayment) was collected in a number of cases at the parent benefit level.
•	In the new PBP, these data are collected at the more discrete benefit level as needed.  We have added variables to account for these data.  Note: We are not populating the data at the parent benefit levels in this case. 

Min/Max variables:  

•	We are mapping code values ‘1: Yes’ and ‘3: Yes with a min & max’ to ‘1: Yes’ in the PBP data extracts.  The min and max columns will always be populated, even when the new PBP has a single value entered.  In that case, the min and max fields will be the same as in prior years. 


In some cases, a plan may have created a POS or OON group without completing the data entry, but failed to delete the group. Where this has occurred, the extracts will show an empty column for those POS and OON groups.

PBP Data Dictionary Notes: 

In the data dictionary, we have added a new column that reflects the JSON question that corresponds to the field title.  

1 - We populated the new column with the JSON question from the “PBP Access column to JSON mapping” document posted in the Documentation section of the HPMS landing page. 

2 - Where the variable is a derived value (i.e., appears in the PBP data extract file, but is not part of the PBP module user interface), we populated the JSON question with DERIVED. 

3 - Where the variable in the PBP data extract file is not used in CY 2024, we populated the JSON question with NOT USED.

CY 2024 PBP Benefits Extract Contents:

Text File:                                     SAS Input Statement to Use:
pbp_b1a_inpat_hosp.txt                         pbp_b1a_inpat_hosp.sas
pbp_b1a_b19a_inpat_hosp_vbid_uf.txt	       pbp_b1a_b19a_inpat_hosp_vbid_uf.sas
pbp_b1a_b19b_inpat_hosp_vbid_uf.txt	       pbp_b1a_b19b_inpat_hosp_vbid_uf.sas
pbp_b1b_inpat_hosp.txt			       pbp_b1b_inpat_hosp.sas
pbp_b1b_b19a_inpat_hosp_vbid_uf.txt	       pbp_b1b_b19a_inpat_hosp_vbid_uf.sas
pbp_b1b_b19b_inpat_hosp_vbid_uf.txt	       pbp_b1b_b19b_inpat_hosp_vbid_uf.sas
pbp_b2_snf.txt				       pbp_b2_snf.sas
pbp_b2_b19a_snf_vbid_uf.txt		       pbp_b2_b19a_snf_vbid_uf.sas
pbp_b2_b19b_snf_vbid_uf.txt		       pbp_b2_b19b_snf_vbid_uf.sas
pbp_b3_cardiac_rehab.txt		       pbp_b3_cardiac_rehab.sas
pbp_b3_b19b_cardiac_rehab_vbid_uf.txt	       pbp_b3_b19b_cardiac_rehab_vbid_uf.sas
pbp_b4_emerg_urgent.txt			       pbp_b4_emerg_urgent.sas
pbp_b4_b19b_emerg_urgent_vbid_uf.txt	       pbp_b4_b19b_emerg_urgent_vbid_uf.sas
pbp_b5_partial_hosp.txt			       pbp_b5_partial_hosp.sas
pbp_b6_home_health.txt			       pbp_b6_home_health.sas
pbp_b7_health_prof.txt			       pbp_b7_health_prof.sas
pbp_b7_b19b_health_prof_vbid_uf.txt	       pbp_b7_b19b_health_prof_vbid_uf.sas
pbp_b8_clin_diag_ther.txt		       pbp_b8_clin_diag_ther.sas
pbp_b9_outpat_hosp.txt			       pbp_b9_outpat_hosp.sas
pbp_b9_b19b_outpat_hosp_vbid_uf.txt	       pbp_b9_b19b_outpat_hosp_vbid_uf.sas
pbp_b10_amb_trans.txt			       pbp_b10_amb_trans.sas
pbp_b10_b19b_amb_trans_vbid_uf.txt	       pbp_b10_b19b_amb_trans_vbid_uf.sas
pbp_b11_dme_prosth_orth_sup.txt		       pbp_b11_dme_prosth_orth_sup.sas
pbp_b12_renal_dialysis.txt		       pbp_b12_renal_dialysis.sas
pbp_b13_other_services.txt		       pbp_b13_other_services.sas
pbp_b13_b19b_other_services_vbid_uf.txt	       pbp_b13_b19b_other_services_vbid_uf.sas
pbp_b13i_b19b_services_vbid_ssbci.txt	       pbp_b13i_b19b_services_vbid_ssbci.sas
pbp_b13i_b19b_other_services_vbid_ssbci.txt    pbp_b13i_b19b_other_services_vbid_ssbci.sas
pbp_b14_preventive.txt			       pbp_b14_preventive.sas
pbp_b14b_b19b_preventive_vbid_uf.txt	       pbp_b14b_b19b_preventive_vbid_uf.sas
pbp_b14c_b19b_preventive_vbid_uf.txt	       pbp_b14c_b19b_preventive_vbid_uf.sas
pbp_b15_partb_rx_drugs.txt		       pbp_b15_partb_rx_drugs.sas
pbp_b16_dental.txt			       pbp_b16_dental.sas
pbp_b16_b19b_dental_vbid_uf.txt		       pbp_b16_b19b_dental_vbid_uf.sas
pbp_b17_eye_exams_wear.txt		       pbp_b17_eye_exams_wear.sas
pbp_b17_b19b_eye_exams_wear_vbid_uf.txt	       pbp_b17_b19b_eye_exams_wear_vbid_uf.sas
pbp_b18_hearing_exams_aids.txt		       pbp_b18_hearing_exams_aids.sas
pbp_b18_b19b_hearing_exams_aids_vbid_uf.txt    pbp_b18_b19b_hearing_exams_aids_vbid_uf.sas
pbp_b19_model_test.txt			       pbp_b19_model_test.sas
pbp_b19a_model_test_vbid_uf.txt		       pbp_b19a_model_test_vbid_uf.sas
pbp_b19b_model_test_vbid_uf.txt		       pbp_b19b_model_test_vbid_uf.sas
pbp_b20.txt				       pbp_b20.sas
pbp_ds_vbid.txt                                pbp_ds_vbid.sas
pbp_mrx.txt             *                      pbp_mrx.sas
pbp_mrx_dmodel.txt      *                      pbp_mrx_dmodel.sas
pbp_mrx_vbid.txt        *                      pbp_mrx_vbid.sas
pbp_mrx_gapCoverage.txt *                      pbp_mrx_gapCoverage.sas
pbp_mrx_p.txt           *                      pbp_mrx_p.sas
pbp_mrx_p_vbid.txt      *                      pbp_mrx_p_vbid.sas
pbp_mrx_tier.txt        *                      pbp_mrx_tier.sas
pbp_mrx_tier_vbid.txt   *                      pbp_mrx_tier_vbid.sas
pbp_mrx_ssm.txt                                pbp_mrx_ssm.sas
pbp_section_a.txt                              pbp_Section_A.sas
pbp_section_c.txt     **                       pbp_Section_C.sas
pbp_section_c_oon.txt **                       pbp_Section_C_oon.sas
pbp_section_c_pos.txt **                       pbp_Section_C_pos.sas
pbp_section_d.txt                              pbp_Section_D.sas
pbp_section_d_oon.txt                          pbp_Section_D_oon.sas
pbp_section_d_opt.txt                          pbp_Section_D_opt.sas
pbp_step1.txt	                               pbp_step1.sas  
pbp_step1_b.txt	                               pbp_step1_b.sas
pbp_step2.txt	                               pbp_step2.sas  
pbp_step2_b.txt	                               pbp_step2_b.sas
pbp_step3.txt	                               pbp_step3.sas
pbp_step4.txt	                               pbp_step4.sas  
pbp_step7B.txt                                 pbp_step7b.sas
pbp_step7F.txt                                 pbp_step7f.sas
pbp_step9.txt	                               pbp_step9.sas
pbp_step10B.txt                                pbp_step10b.sas
pbp_step13.txt	                               pbp_step13.sas                              
pbp_step14.txt	                               pbp_step14.sas  
pbp_step16A.txt                                pbp_step16a.sas
pbp_step16B.txt                                pbp_step16b.sas
pbp_step17A.txt                                pbp_step17a.sas
pbp_step17B.txt                                pbp_step17b.sas
pbp_step18A.txt                                pbp_step18a.sas
pbp_step18B.txt                                pbp_step18b.sas
pbp_step20.txt	                               pbp_step20.sas
pbp_vbid.txt                                   pbp_vbid.sas
PlanArea.txt       ***                         planArea.sas
PlanRegionArea.txt ***                         planRegionArea.sas

*The pbp_mrx files for 2024 have been split into eight files:
pbp_mrx.txt
pbp_mrx_dmodel.txt
pbp_mrx_vbid.txt
pbp_mrx_gapCoverage.txt
pbp_mrx_p.txt
pbp_mrx_p_vbid.txt
pbp_mrx_tier.txt
pbp_mrx_tier_vbid.txt

*The PlanArea.txt file is available for Local MA and EDPDP-FB plans; the PlanRegionArea.txt file is available for Regional MA plans and PDPs.

pbp_SectionA.txt - Contains general plan information.

pbp_b1a_inpat_hosp.txt, pbp_b1b_inpat_hosp.txt - Inpatient Hospital Acute/Psychiatric data.

pbp_b1a_b19a_inpat_hosp_vbid_uf.txt, pbp_b1a_b19b_inpat_hosp_vbid_uf.txt, pbp_b1b_b19a_inpat_hosp_vbid_uf.txt, pbp_b1b_b19b_inpat_hosp_vbid_uf.txt - Inpatient Hospital Acute/Psychiatric VBID and UF reduced cost data.

pbp_b2_snf.txt - Skilled Nursing Facility data.

pbp_b2_b19a_snf_vbid_uf.txt, pbp_b2_b19b_snf_vbid_uf.txt - Skilled Nursing Facility VBID and UF data.

pbp_b3_cardiac_rehab.txt - Cardiac and Pulmonary Rehabilitation data.

pbp_b3_b19b_cardiac_rehab_vbid_uf.txt - Cardiac and Pulmonary Rehabilitation VBID and UF data.

pbp_b4_emerg_urgent.txt - Emergency/Urgent Care data.

pbp_b4_b19b_emerg_urgent_vbid_uf.txt - Emergency/Urgent Care VBID and UF data.

pbp_b5_partial_hosp.txt - Partial Hospitalization data.

pbp_b6_home_health.txt - Home Health data.

pbp_b7_health_prof.txt - Contains Health Care Professional data for Primary Care Physician, Chiropractic, Occupational Therapy, Physician Specialist and Mental Health Specialist services.
                         
pbp_b7_b19b_health_prof_vbid_uf.txt - Contains Health Care Professional VBID and UF data for Primary Care Physician, Chiropractic, Occupational Therapy, Physician Specialist and Mental Health Specialist services.

pbp_b8_clin_diag_ther.txt - Outpatient Clinical, Diagnostic, and Therapeutic Radiology services data.

pbp_b9_outpt_hosp.txt - Outpatient Hospital, ASC, Outpatient Substance Abuse, and Cardiac Rehabilitation data.
                        
pbp_b9_b19b_outpat_hosp_vbid_uf.txt - Outpatient Hospital, ASC, Outpatient Substance Abuse, and Outpatient Blood VBID and UF data.

pbp_b10_amb_trans.txt - Ambulance/Transportation data.

pbp_b10_b19b_amb_trans_vbid_uf.txt - Ambulance/Transportation VBID and UF data.

pbp_b11_dme_prosth_orth_sup.txt - Durable Medical Equipment, Prosthetics/Orthotics and Medical Supplies data.
                                  
pbp_b12_renal_dialysis.txt - Renal Dialysis data.

pbp_b13_other_services.txt - Outpatient Blood, Acupuncture and "Other" services data. The "Other" data describes benefits not included in standard PBP service categories.
                             
pbp_b13_b19b_other_services_vbid_uf.txt - Acupuncture, OTC, Meal Benefit and "Other" services VBID and UF data. The "Other" data describes benefits not included in standard PBP service categories.

pbp_b13i_b19b_services_vbid_ssbci.txt - Non-Primarily Health Related Benefits for the Chronically III, Food and Produce, Meals, Pest Control, Transportation fr Non-Medical Needs, Indoor Air Quality Equipment and Services and Other data.

pbp_b13i_b19b_other_services_vbid_ssbci.txt - "Other" Non-Primarily Health Related Benefits for the Chronically III data. 

pbp_b14_preventive.txt - Contains Preventive Services data for Health Education/Wellness, Immunizations, Routine Physicals, and Pap/Pelvic Exams.
                         
pbp_b14b_b19b_preventive_vbid_uf.txt - Contains Preventive Services VBID and UF data for Immunizations, Routine Physicals, and Pap/Pelvic Exams.

pbp_b14c_b19b_preventive_vbid_uf.txt - Contains Supplemental Benefits Preventive Services VBID and UF data for Health Education/Wellness, Fitness Benefit,Counseling Services.

pbp_b15_partb_rx_drugs.txt -  Medicare Part B prescription drugs.

pbp_b16_dental.txt - Preventive and Comprehensive Dental data.

pbp_b16_b19b_dental_vbid_uf.txt - Preventive and Comprehensive Dental VBID and UF data.

pbp_b17_eye_exams_wear.txt - Eye Exams and Eye Wear data.

pbp_b17_b19b_eye_exams_wear_vbid_uf.txt - Eye Exams and Eye Wear VBID and UF data.

pbp_b18_hearing_exams_aids.txt - Hearing Exams and Hearing Aids data.

pbp_b18_b19b_hearing_exams_aids_vbid_uf.txt - Hearing Exams and Hearing Aids VBID and UF data.

pbp_b19_model_test.txt - Model Test VBID and UF

pbp_b19a_model_test_vbid_uf.txt - Model Test VBID and UF

pbp_b19b_model_test_vbid_uf.txt - Model Test VBID and UF

pbp_b20.txt - Contains enhanced Prescription Drug data for Cost Plans if they do NOT offer Part D drug benefits.

pbp_Section_C.txt - Contains Out-of-Network data for PPO plans.

pbp_section_c_oon.txt - Out-of-Network

pbp_section_c_pos.txt - Point of Service

pbp_Section_D.txt - Contains plan-level financial data such as plan premiums, global max plan benefit and out-of-pocket limits, and global deductibles.

pbp_section_D_oon.txt - Contains plan-level out-of-network deductibles and out-of-pocket limits.

pbp_Section_D_opt.txt - Contains plan-level benefit data descriptions of optional supplemental offerings including the optional benefit premium amounts.

pbp_mrx.txt - Contains Medicare Part D prescription drug benefits data.

pbp_mrx_vbid.txt - Contains Medicare Part D prescription drug benefits VBID data.

pbp_mrx_gapCoverage.txt - Contains information on coverage of either tier(s) or specific drugs through the entire gap (ICL to catastrophic).

pbp_mrx_p.txt - Contains Medicare Part D prescription drug benefits (post OOP threshold) data.
                
pbp_mrx_p_vbid.txt - Contains Medicare Part D prescription drug benefits (post OOP threshold) VBID data.

pbp_mrx_tier.txt - Contains Medicare Part D prescription drug benefits (tiering) data.

pbp_mrx_tier_vbid.txt - Contains Medicare Part D prescription drug benefits (tiering) data.

pbp_step1.txt      - Contains Step-up details for service category B1.                       

pbp_step1_b.txt	   - Contains Step-up details for service category  B1_B.                         

pbp_step2.txt	   - Contains Step-up details for service category  B2.                        

pbp_step2_b.txt	   - Contains Step-up details for service category B2_B.                          

pbp_step3.txt	   - Contains Step-up details for service category B3.                         

pbp_step4.txt	   - Contains Step-up details for service category  B4. 

pbp_step7b.txt     - Contains step-up chiropractic benefit data.

pbp_step7f.txt     - Contains step-up podiatry benefit data.

pbp_step9.txt	   - Contains Step-up details for service category B9.                          

pbp_step10b.txt - Contains step-up transportation benefit data.
                           
pbp_step13.txt	   - Contains Step-up details for service category B13.                                                       

pbp_step14.txt	   - Contains Step-up details for service category B14. 

pbp_step16a.txt - Contains step-up preventive dental data.

pbp_step16b.txt - Contains step-up comprehensive data.

pbp_step17a.txt - Contains step-up eye exams data.

pbp_step17b.txt - Contains step-up eye wear data.

pbp_step18a.txt - Contains step-up hearing exams data.

pbp_step18b.txt - Contains step-up hearing aids data.
                           
pbp_step20.txt	- Contains Step-up details for service category B20. 

pbp_ds_vbid.txt - Contains DS VBID benefit data.

pbp_mrx_dmodel.txt - Contains Part D model references data.
pbp_mrx_ssm.txt - Contains Part D SSM  benefit data.

pbp_vbid.txt - Contains VBID general data.

planarea.txt and planRegionArea.txt - Contains Service Area data by plan (includes EGHP service areas).

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If you are importing the data into Excel, you must define certain columns as text or you will lose any leading zero information (example, a plan id of '001' will 
appear as '1' if defined as "general" or "numeric.").  The variable names for the columns that should be delineated as text (or character in SAS terminology) are 
provided within the SAS input statements as well as the PBP_Benefits_2024_dictionary.xlsx.

