Readme_PBP_Benefits_2015.txt

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 2015 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 2015 
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.

CY 2015 PBP Benefits Extract Contents:

Text File:                              SAS Input Statement to Use:

pbp_b1a_inpat_hosp.txt                  pbp_b1a.sas
pbp_b1b_inpat_hosp.txt                  pbp_b1b.sas
pbp_b2_snf.txt                          pbp_b2.sas
pbp_b3_corf.txt                         pbp_b3.sas
pbp_b4_emerg_urgent.txt                 pbp_b4.sas
pbp_b5_partial_hosp.txt                 pbp_b5.sas
pbp_b6_home_health.txt                  pbp_b6.sas
pbp_b7_health_prof.txt                  pbp_b7.sas
pbp_b8_clin_diag_ther.txt               pbp_b8.sas
pbp_b9_outpat_hosp.txt                  pbp_b9.sas
pbp_b10_amb_trans.txt                   pbp_b10.sas
pbp_b11_dme_prosth_orth_sup.txt         pbp_b11.sas
pbp_b12_renal_dialysis.txt              pbp_b12.sas
pbp_b13_other_services.txt              pbp_b13.sas
pbp_b13h_other_services_1.txt           pbp_b13h_1.sas
pbp_b13h_other_services_2.txt           pbp_b13h_2.sas
pbp_b14_preventive.txt                  pbp_b14.sas
pbp_b15_partb_rx_drugs.txt              pbp_b15.sas
pbp_b16_dental.txt                      pbp_b16.sas
pbp_b17_eye_exams_wear.txt              pbp_b17.sas
pbp_b18_hearing_exams_aids.txt          pbp_b18.sas
pbp_b20.txt                             pbp_b20.sas
pbp_mrx.txt                             pbp_mrx.sas
pbp_mrx_gapCoverage.txt                 pbp_mrx_gapCoverage.sas
pbp_mrx_p.txt                           pbp_mrx_p.sas
pbp_mrx_tier.txt                        pbp_mrx_tier.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_opts.txt                  pbp_Section_D_opt.sas
pbp_step7B.txt                          pbp_step7b.sas
pbp_step7F.txt                          pbp_step7f.sas
pbp_step10B.txt                         pbp_step10b.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
PlanArea.txt       *                    planArea.sas
PlanRegionArea.txt *                    planRegionArea.sas

Note that only Sections B, C, and D are not relevant for PDPs and
EDPDPs/FBs and, therefore, not included for these plan type extracts.
The files for Sections C and D (including the D Optional) are not relevant
for PDPs and EDPDPs/FBs and, therefore, not included for
these plan type extracts.

*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_b1_inpat_hosp.txt - Inpatient Hospital Acute/Psychiatric data.

pbp_b2_snf.txt - Skilled Nursing Facility data.

pbp_b3_corf.txt - Comprehensive Outpatient Rehabilitation Facility data.

pbp_b4_emerg_urgent.txt - Emergency/Urgent Care 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_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_b10_amb_trans.txt - Ambulance/Transportation 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_b13h_other_services.txt - EPSDT Services, Tobacco Cessation Counseling for Pregnant Women, 
                              Freestanding Birth Center Services, Respiratory Care Services, 
                              Family Planning Services, Nursing Home Services, 
                              Home and Community Based Services, Personal Care Services, 
                              Self-Directed Personal Assistance Services, Private Duty Nursing Services, 
                              Case Management, Institution for Mental Disease Services for individuals 65 
                              or Older, Services in an Intermediate Care Facility for the Mentally Retarded
                              and "Other" services data.  The "Other" data include benefits covered by Medicaid 
                              or as demonstration-specific additional benefits and included in MMP plan 
                              benefit packages.

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

pbp_b15_partb_rx_drugs.txt -  Medicare Part B prescription drugs.

pbp_b16_dental.txt - Preventive and Comprehensive Dental data.

pbp_b17_eye_exams_wear.txt - Eye Exams and Eye Wear data.

pbp_b18_hearing_exams_aids.txt - Hearing Exams and Hearing Aids data.

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_opts.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_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_tier.txt - Contains Medicare Part D prescription drug benefits
                   (tiering) data.

pbp_step10b.txt - Contains step-up transportation benefit data.

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_step7b.txt - Contains step-up chiropractic benefit data.

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

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

                                            ******
                                            
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.