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 |