Patient Residence Code

SAS Name
PTNT_RSDNC_CD

This variable indicates where the beneficiary lived when the prescription was filled, as reported on the PDE record.

Comments

CMS requires Part D plans to maintain pharmacy networks that are sufficient to ensure convenient access to Medicare beneficiaries – including retail, home infusion, and long-term care pharmacies. This variable is designed to help CMS and plan sponsors monitor beneficiary access to a range of “in-network” pharmacies.

This variable was new in 2013 and required for all PDEs beginning on February 28, 2013.

Note that the location indicated by this variable may not correspond with other information regarding beneficiary residence – such as Medicare Part A or B claims or Minimum Data Set (MDS) assessment information.

Source: PDE

Code Code value
00 Not specified, other patient residence not identified below
01 Home
02 Skilled Nursing Facility
03 Nursing facility (long-term care facility)
04 Assisted living facility
05 Custodial Care Facility (residential but not medical care)
06 Group home (e.g., congregate residential foster care)
07 Inpatient Psychiatric Facility
08 Psychiatric Facility – Partial Hospitalization
09 Intermediate care facility for the mentally retarded (ICF/MR)
10 Residential Substance Abuse Treatment Facility
11 Hospice
12 Psychiatric Residential Treatment Facility
13 Comprehensive Inpatient Rehabilitation Facility
14 Homeless Shelter
15 Correctional Institution