Updated research request forms and data security approval required beginning 4/24/23
Data File Search
What does this file include? (variable highlights)
Resource Utilization Group (RUG) code
Clinical status measures
Physical functioning assessment
Psychological status measures
Psycho-social functioning measure
Program:
Medicare, Medicaid
What does this file include? (variable highlights)
Resource Utilization Group (RUG) code
Clinical status measures
Physical functioning assessment
Psychological status measures
Psycho-social functioning measure
End-of-life care decisions
Program:
Medicare, Medicaid
What does this file include? (variable highlights)
Resource Utilization Group (RUG) code
Clinical status measures
Physical functioning assessment
Psychological status measures
Psycho-social functioning measure
Program:
Medicare, Medicaid
Healthcare providers/populations addressed by specific, individual surveys include:
Hospital
Home Health
Home and Community Based Services
Fee-for-Service
Medicare Advantage & Part D Plan (PDP)
In-Center Hemodialysis
Nationwide Adult Medicaid
Hospice
Accountable Care Organizations
Outpatient and Ambulatory Surgery
Merit-based Incentive Payment System quality payment program
Measures of beneficiary experience focus on the patient experience or perception rather than patient satisfaction. Focus areas…
Program:
Medicare
What does this file include? (variable highlights)
HRS data include:
Demographic and background information, including household
Physical and mental health
Cognition
Functional limitations
Employment
Disability
Health insurance
Assets and Income
Wills, including advanced directives
Linked files include:
Medicare denominator/Beneficiary Summary File (BSF)
Medicare fee-for-service (FFS) claims
Inpatient, MedPAR, Outpatient, Durable Medical Equipment (DME), Carrier, Skilled Nursing…
Program:
Medicare
HOS variables contain the following information in a baseline survey and two-year follow-up survey:
Demographic information including primary language
Disability status
Physical and mental health status
HEDIS Effectiveness of Care measures
Health-related quality of life (HRQOL)
Special considerations
CMS will provide additional file specifications to researchers with approved data requests.
Information on the survey and data can be found on the Medicare Health Outcomes Survey website.
Program:
Medicare
The Healthcare Effectiveness Data and Information Set (HEDIS) Patient-Level Detail (PLD) files are a set of standardized healthcare quality measures designed to provide information for reliable comparison of health plan performance. The HEDIS PLD data are submitted annually by Medicare Advantage (MA) Organizations, Cost Plans, and Demonstration Plans and contribute to the assignment of CMS Star Ratings for MA plans.
HEDIS data are released as a set of two files per year:
File 1: HEDIS Measures File (does…
Program:
Medicare
What does this file include? (variable highlights)
Colorectal cancer screening
Comprehensive diabetes care (multiple measures)
High risk medication usage
Each record represents the experience of a beneficiary in a specific plan for the calendar year (CY). Beneficiaries enrolled in more than one plan during the CY will have multiple records in this file.
Beneficiaries can be linked to other beneficiary data via the BENE_ID and to plan information via the HEDIS_CONTRACT_ID and HEDIS_PLAN_ID variables.
Program:
Medicare
What does this file include? (variable highlights)
Readmission indicator
Chronic condition weight
Each record represents a hospitalization for a beneficiary in the calendar year (CY). Beneficiaries with multiple hospitalizations will have multiple records in this file.
Beneficiaries can be linked to other beneficiary data via the BENE_ID and to plan information via the HEDIS_CONTRACT_ID and HEDIS_PLAN_ID variables.
Program:
Medicare
What does this file include? (variable highlights)
The MD-PPAS contain data on specialty, TIN practice assignment, place of service information, provider demographics, geographic location, and summary Medicare utilization measures for over 1.2 million providers.
The MD-PPAS has been updated to version 2.4 from version 2.3 to reflect the following changes:
The MD-PPAS data include a modified broad specialty variable that provides a more detailed breakdown of non-physician specialties.
The data also…
Program:
Medicare
What does this file include? (variable highlights)
ACO ID
Assigned in Preliminary/Prospective Assignment Period
Assigned in Quarter 1
Assigned in Quarter 2
Assigned in Quarter 3
Assigned in Quarter 4
Assigned in Final Reconciliation
Part D Eligible Months
HICN (populated in PY2013-PY2019/2019-A)
Date of birth
Date of death
Gender
Race
Medicare Beneficiary Identifier (MBI)
Special considerations
This file can be linked to any other CMS file that includes the Bene ID.
These files differ from the…
Program:
Medicare
What does this file include? (variable highlights)
ACO ID
ACO Name
Start Date
Tax Identification Number (TIN) of ACO Participant
TIN Legal Business Name
National Provider Identifier (NPI) for practitioner
Name of Provider Associated with the NPI
CMS Certification Number (CCN; formerly OSCAR number)
CCN Facility Type
CCN Facility Type Description
Provider Specialty Code
ACO Location (county primarily served)
Year of ACO Source Record
Special considerations
Shared Savings Program RIFs do not…
Program:
Medicare
What does this file include (variable highlights)
Beneficiary ID (allows linkage to other files)
ESCO Name
Monthly assignment status information
Date of birth
Date of death
Special Considerations
This file can be linked to any other CMS file that includes the Bene ID.
PY1 is for a 15 month period beginning in October, all other PYs are for a calendar year beginning in January.
All technical questions related to the CEC program should be directed to ESRD-CMMI@cms.hhs.gov.
Program:
Medicare
What does this file include? (variable highlights)
ESCO Name
Period of Performance
Tax Identification Number of the practice/facility associated with the Individual NPI
Parent Participant NPI Number
Organization Name
Provider Type description
CMS Certification Number (CCN)
Special considerations
This file can be linked to any other CMS file that include the TIN, CCN, or NPI.
PY1 is for a 15 month period beginning in October, all other PYs are for a calendar year beginning in January.
All technical…
Program:
Medicare
What does this file include? (variable highlights)
Beneficiary ID (allows linkage to other files)
ACO Name
Monthly assignment status information
Date of Birth
Date of Death
Special considerations
This file can be linked to any other CMS file that includes the BeneID
Beneficiaries can be linked to their assigned providers by linking the ACO_ID in the provider file to the ACO_NUM in the beneficiary file
Questions regarding the Next Generation ACO Model can be directed to NextGenerationACOModel@cms.hhs.gov
Program:
Medicare
What does this file include? (variable highlights)
ACO identifier
Performance year
Organization Name
CMS organization identifiers including Tax Identification Number, CMS Certification Number (CCN)
Provider type description
Special considerations
This file can be linked to any other CMS file that contains the ORG_TIN, ORG_NPI or ORG_CCN
Providers can be linked to their assigned beneficiaries by linking the ACO_ID in the provider file to the ACO_NUM in the beneficiary file
Questions regarding the Next…
Program:
Medicare
The NHATS interview data include:
Residence
Health conditions
Housing/household
Functional status
Insurance
Labor force participation
The NHATS interview data are linked to CMS Medicare claims data for information on healthcare use.
Special considerations
The NHATS website has information on obtaining this restricted data.
Program:
Medicare
This file includes (variable highlights):
Special services, treatments, and interventions
For example: ventilator use, dialysis, chemotherapy, central line placement, total parenteral nutrition, high risk drugs
Medical conditions and co-morbidities
Cognitive function
Mental status including depression and dementia
Ability to communicate
Special considerations:
This is a standalone file and cannot be linked to any other RIF data.
Program:
Medicare
What does this file include? (variable highlights)
Beneficiary identifiers
Practice identifier for the practice to which the beneficiary was attributed
Number and percent of primary care services provided to the beneficiary that were billed by the practice
HCC percentile risk score
Special considerations
Data documentation is specific to each performance year.
This RIF can be linked to any other CMS file that includes the Bene ID.
Two additional VM program RIFs are available:
VM Practice-Level RIF…
Program:
Medicare
What does this file include? (variable highlights)
Practice Identifier
Eligible professional NPI
Eligible professional subject to the VM
Provider specialty
No practice-level Quality and Resource Use Report (QRUR) or VM information (must link to VM Practice-Level RIF)
Special considerations
Data documentation is specific to each performance year.
Two additional VM program RIFs are available:
VM Practice-Level RIF
VM Beneficiary-Level RIF
Program:
Medicare
What does this file include? (variable highlights)
Practice Identifier
Quality and Resource Use Report (QRUR) information
VM information
Benchmark information
Special considerations
Data documentation is specific to each performance year.
This RIF includes thousands of records with hundreds of variables.
Can be linked to provider NPI in the VM NPI-Practice-Level RIF
Two additional VM program RIFs are available:
VM NPI-Practice-Level RIF
VM Beneficiary-Level File RIF
Program:
Medicare
Source data
Medicare: FFS, PDE and MA
Medicaid: MAX data
What does this file include? (variable highlights)
Eligibility, enrollment variables
Aggregated cost and use
Medicare: FFS, PDE includes FFS and MA
Medicaid: FFS, managed care encounter where available
Prescription Drug service utilization reported for classes of drugs
Chronic Condition flags - 27 CCW Chronic Conditions plus an additional 25 other condition flags
All four files are released for approved MMLEADS data requests
Beneficiary file
Medicare…
Program:
Medicare, Medicaid
What does this file include? (variable highlights)
Provider file
Pioneer ACO ID
Tax identification number
Provider specialty code
Beneficiary file
Bene ID
Pioneer ACO ID
Aggregated expenditures and claim counts
Settlement file
Pioneer ACO ID
Beneficiary counts
Performance year expenditures and savings
Special considerations
Each file needs to be specified separately on a data request.
Only the Pioneer ACO Beneficiary file can be linked to other CMS data via the Bene ID.
Program:
Medicare
What is different about MMLEADS 3.0?
MMLEADS now consists of two files—a beneficiary summary file and single cost (i.e., payments) and use (i.e., claim counts) file that combines Medicare and Medicaid information. CCW Chronic Condition and other condition flags are no longer provided.
Source data
Medicare: FFS, PDE and MA
Medicaid: T-MSIS data
What does this file include? (variable highlights)
Eligibility, enrollment variables
Aggregated claim counts and payment amounts
Medicare: FFS, PDE includes FFS and MA…
Program:
Medicare, Medicaid