Data Dictionary for Part_D_5Pct_Medicare_11APR05


VARIABLE LABEL LENGTH TYPE VALUES DESCRIPTION SOURCE
A_MO_CNT_{YEAR} Number of Part A months 4 num 0-12 The number of months the beneficiary is enrolled in Part A Medicare in the calendar year (CY). Denominator File
AB_MO_CNT_{YEAR} Number of Part A and B months 4 num 0-12 The number of months the beneficiary is enrolled in Part A and Part B Medicare in the calendar year. Denominator File
AGE_{YEAR} Age on January 1 of CY 4 num 0-110 The age of the beneficiary on January 1st of the calendar year. Denominator File
ALIVE_MO_CNT_{YEAR} Number of full months alive 4 num 0-12 The number of months elapsed between January 2001 and the date of the beneficiary's death. Value is 12 if beneficiary survived through the reference year. Denominator File
B_MO_CNT_{YEAR} Number of Part B months 4 num 0-12 The number of months the beneficiary is enrolled in Part B Medicare in the calendar year. Denominator File
HMO_MO_CNT_{YEAR} Number of HMO months 4 num 0-12 Number of months the beneficiary is enrolled in Medicare Advantage in the calendar year. Denominator File
ID Unique personal identifier 32 char alphanumeric Individual identifier. Randomly Assigned
INST_MO_CNT_{YEAR} Number of months residing in nursing homes in CY 3 num 0-12 The number of months a beneficiary spent more than one day in a facility according to Minimum Data Set assessments in the calendar year (CY). MDS (Minimum Data Set)
LT_STATUS_{YEAR} Long-term care institutional status in CY 3 num 0-1 This variable takes the value of 1 if a beneficiary's length of stay in a long-term institution (LTI) , starting from the admission date, exceeds 90 consecutive days. A beneficiary who was admitted to a LTI before January 1, {YEAR} can have LT_STATUS_{YEAR} = 1 if the sum of consecutive LTI days in {YEAR-1} and {YEAR} is greater than 90. MDS (Minimum Data Set)
MC_MO_CNT_{YEAR} Number of months Medicaid coverage 4 num 0-12 The number of months the beneficiary is enrolled in Medicaid in the calendar year. Denominator File
MS_CD_{YEAR} Medicare status code 2 char 10,11,20,21,31 The reason for the beneficiary's entitlement to Medicare benefits, as of beginning of the calendar year. Denominator File
NEW_ENROLLEE_{YEAR} HCC model new enrollee flag 3 num 0,1 Indicator that flags beneficiaries who had fewer than 12 months of Part A and B fee-for-service enrollment in the calendar year. This is the definition of "new enrollee" in the CMS-HCC model. Denominator File
SEX Sex 1 char 1,2 The gender of the beneficiary. Denominator File
DRG_{YEAR}_1-DRG_{YEAR}_6 Diagnosis Related Group (DRG) codes in CY 3 char 000-533 Diagnosis Related Groups (DRGs) corresponding to the first six fee-for-service inpatient stays within the year, even if repeated. Each DRG represents broad clinical categories that are similar in their use of diagnostic resources. Inpatient Standard Analytical File
HCC_{YEAR}_1-HCC_{YEAR}_177 Hierarchical Condition Categories (HCCs) in CY 3 num 0,1 An indicator that specifies if the fee-for-service beneficiary had a given Hierarchical Condition Category (HCC) during the calendar year. Only the 70 HCCs used in the CMS-HCC model are included in this data set, but the numbering corresponds to the CMS numbering of the full set. For more background see: http://www.cms.hhs.gov/healthplans/riskadj/PilotReporttoplansfn.pdf Inpatient, Outpatient, Physician/Supplier Standard Analytical File
H_PTABRMB_{YEAR} Total Part A and B Medicare reimbursements 8 num continuous The sum of all Medicare fee-for-service reimbursements made during the calendar year for services covered by institutional claims, or for services included as a line item on a physician, supplier, or durable medical equipment (DME) claim. Inpatient, SNF, Hospice, Physician/Supplier, Outpatient, Durable Medical Equipment (DME) and HHA Standard Analytical Files
H_PTARMB_{YEAR} Total Part A Medicare reimbursements 8 num continuous The sum of Medicare fee-for-service reimbursements for services covered by inpatient, skilled nursing facility (SNF), hospice, and Part A home health agency (HHA) claims. Inpatient, SNF, Hospice, and HHA Standard Analytical Files
H_PTBRMB_{YEAR} Total Part B Medicare reimbursements 8 num continuous The sum of Medicare fee-for-service reimbursements for services covered by outpatient, physician, (durable medical equipment (DME), and Part B home health agency (HHA) claims Physician/Supplier, Outpatient, Durable Medical Equipment (DME) and HHA Standard Analytical Files
H_INPSTY_{YEAR} Number of inpatient admissions for CY 8 num continuous The number of fee-for-service stays at inpatient facilities during the calendar year. Inpatient Standard Analytical File
H_OUTVST_{YEAR} Number of outpatient visits for CY 8 num continuous The number of fee-for-service outpatient visits during the calendar year. Outpatient Standard Analytical File
H_PMTVST_{YEAR} Number office visits for CY 8 num continuous The number of fee-for-service office visits during the calendar year. Office visits are identified by HCPCS codes in the series 90000-90090 and 99201-99215 in the Part B line item trailer group(s). Physician/Supplier Standard Analytical File
H_SNFDAY_{YEAR} Number of SNF covered days for CY 8 num continuous The sum of skilled nursing facility (SNF) covered fee-for-service days of care that are chargeable to Medicare facility utilization. Skilled Nursing Facility (SNF) Standard Analytical File
RISK_RX_EXP_{YEAR} Drug expenditure risk score 8 num continuous CMS RXHCC total expenditures risk score, derived from diagnoses from calendar year 2000 and the CMS-RXHCC software. This score reflects predicted total drug expenditures for the beneficiary in 2001. Only beneficiaries on both Parts A and B of fee-for-service Medicare in January 2001 get a risk score. The risk score is calculated by dividing the risk value (the output of the CMS-RXHCC software) by the mean risk value of beneficiaries on both Parts A and B of fee-for-service Medicare in July 2001. Inpatient, Outpatient, Physician/Supplier Standard Analytical File
RISK_RX_LIAB_{YEAR} Plan liability risk score 8 num continuous CMS RXHCC plan liability risk score, derived from diagnoses from calendar year 2000 and the CMS-RXHCC software. This score reflects predicted plan liabilities for the beneficiary's drug expenditures in 2001. Only beneficiaries on both Parts A and B of fee-for-service Medicare in January 2001 get a risk score. The risk score is calculated by dividing the risk value (the output of the CMS-RXHCC software) by the mean risk value of beneficiaries on both Parts A and B of fee-for-service Medicare in July 2001. Inpatient, Outpatient, Physician/Supplier Standard Analytical File
RISK_SCORE_{YEAR} HCC risk scores 8 num continuous CMS HCC risk score, derived from HCCs from calendar year 2000 and the CMS-HCC software. These would be used to predict Medicare Part A and B payments in 2001. Only beneficiaries on both Parts A and B of fee-for-service Medicare in January 2001 get a risk score. The risk score is calculated by dividing the risk value (the output of the CMS-HCC software) by the mean risk value of beneficiaries on both Parts A and B of fee-for-service Medicare in July 2001. Inpatient, Outpatient, Physician/Supplier Standard Analytical File
INS_STATUS Insurance status 1 char 1-4 Imputed health insurance and drug coverage insurance for 2006. Imputed from MCBS
RX_EXP_AWP_WCOVERAGE Annual drug expenditures in terms of AWP with drug coverage 8 num continuous Imputed annual Average Wholesale Price (AWP) prescription drug expenditures in 2006$, assuming a beneficiaries have supplemental insurance with drug coverage.  For beneficiaries with INS_STATUS = 4, Supplemental w/ Drug Coverage, RX_EXP_AWP_WCOVERAGE is equal to RX_EXPENDITURES_AWP.  For all other beneficiaries, RX_EXP_AWP_WCOVERAGE is imputed by setting INS_STATUS = 4 in all simulations while leaving the remaining characteristics unchanged. Imputed from MCBS
RX_EXP_WCOVERAGE Annual reported community drug expenditures with drug coverage 8 num continuous Imputed community annual prescription drug expenditures in 2006$ for beneficiaries who had zero days in facilities and skilled nursing facilities, assuming beneficiaries have supplemental insurance with drug coverage.  For beneficiaries with INS_STATUS = 4, Supplemental w/ Drug Coverage, RX_EXP_WCOVERAGE is equal to RX_EXPENDITURES.  For all other beneficiaries, RX_EXP_WCOVERAGE is imputed by setting INS_STATUS = 4 in all simulations while leaving the remaining characteristics unchanged. Imputed from reported community expenditures in the MCBS
RX_EXPENDITURES Annual reported community drug expenditures 8 num continuous Imputed annual prescription drug expenditures in 2006$ for beneficiaries who had zero days in facilities and skilled nursing facilities, assuming insurance status designated by the variable INS_STATUS. Imputed from reported community expenditures in the MCBS
RX_EXPENDITURES_AWP Annual drug expenditures in terms of AWP 8 num continuous Imputed annual prescription drug expenditures in terms of average wholesale prices (AWP) in 2006$, assuming insurance status designated by the variable INS_STATUS. Includes community and long-term care drug expenses. Imputed from MCBS
RX_SCRIPTS Annual number of prescriptions 3 num continuous Imputed annual number of prescriptions for the beneficiary in calendar year 2001. Imputed from MCBS
RX_SCRIPTS_WCOVERAGE Annual number of prescriptions with drug coverage 3 num continuous Imputed annual number of prescriptions for the beneficiary in calendar year 2001, assuming beneficiaries have supplemental insurance with drug coverage. For beneficiaries with INS_STATUS = 4, Supplemental w/ Drug Coverage, RX_SCRIPTS_WCOVERAGE is equal to RX_SCRIPTS.  For all other beneficiaries, RX_SCRIPTS_WCOVERAGE is imputed by setting INS_STATUS = 4 in all simulations while leaving the remaining characteristics unchanged. Imputed from MCBS
CENSUS_REGION_{YEAR} Census region 2 char 01-10,99 The census region of the beneficiary's residence. Denominator File
METRO_STATUS_{YEAR} Metro status 1 char 0-3 Indicator that specifies whether the beneficiary lived in a Metropolitan Statistical Area (MSA) as of beginning of the calendar year. Denominator File and 2001 CMS MSABEA county file
STATE_{YEAR} State code (SSA) 2 char 1-99 The Social Security Administration (SSA) standard state code of the beneficiary's residence as of beginning of the CY. Denominator File