The MBSF base segment includes beneficiary enrollment information, (A/B/C/D). Medicare Advantage (Part C) and the Prescription Drug Program (Part D) plan enrollment information is included.

The 30 CCW Chronic Conditions segment of the Master Beneficiary Summary File (MBSF) flags each Medicare beneficiary for the presence of one of 30 specific chronic conditions.

The Chronic Conditions segment of the Master Beneficiary Summary File (MBSF) flags each Medicare beneficiary for the presence of one of 27 specific chronic conditions.

The Other Chronic or Potentially Disabling Conditions segment of the MBSF flags beneficiary records for the presence of 35 chronic or potentially disabling conditions not included in the original list of 27 conditions, including:

• Mental health
• Tobacco use, alcohol and drug use
• Developmental disorders
• Disability-related conditions
• Behavioral health
• Other chronic physical conditions

The Cost and Use file segment of the MBSF includes one record for each beneficiary enrolled in Medicare in the calendar year of the file.

This segment includes cause of death information from death certificates provided through linkage with the National Death Index (NDI).

The Risk Score Files are created from the final CMS risk adjustment model outputs for a payment year. These risk scores are used to adjust CMS payments to Medicare Advantage (Part C) plans to account for differences in relative costs among plan enrollees. At this time, only Payment Year (PY)14 risk score files are available for research use.  

Please see the Medicare Managed Care Manual, Chapter 7 for a discussion of risk adjustment in the Medicare Advantage program.

The Plan Characteristics file contains Medicare Advantage plan and Prescription Drug Plan information separated into six subfiles.

The subfiles are:

• Plan Base
• Premium
• Tier
• Service Area
• Plan Crosswalk
• SNP Contract

The Medicaid and CHIP TAF (T-MSIS Analytic File) Demographic and Eligibility (DE) file contains one record for every individual eligible for and enrolled in Medicaid or CHIP for at least one day during the file calendar year.

Medicaid MAX (Medicaid Analytic Extract) Personal Summary (PS) file contains one record for every individual eligible for and enrolled in Medicaid for at least one month or who had a Medicaid-paid service within the file year.

The Conditions segment of the MESF flags each Medicaid beneficiary for the presence of one of 27 specific chronic conditions or one of 35 other chronic or potentially disabling conditions.

The National Death Index segment of the MESF includes cause of death information from death certificates provided through linkage with the National Death Index (NDI) cause of death information.

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.

The HEDIS Measures file is a person-level file that includes information about all HEDIS measures, except the Plan All-Cause Readmission measure, which is included in HEDIS File 2. It represents beneficiaries enrolled in each MA plan/contract during the year. The file contains indicator variables for whether the beneficiary met the denominator and numerator requirements for each of the HEDIS measures, as well as weights for some measures.

The HEDIS Medicare Advantage Plan All-Cause Readmissions (PCR) File (referred to as File 2 in the file name) is a patient-level file that contains all variables pertinent to the PCR measure. There is a separate record for each acute inpatient hospital discharge during the year.

CMS has created an analytical file that contains enrollment data for beneficiaries in the Comprehensive ESRD Care (CEC) Model. A related file, the CEC Provider RIF, contains identifying information about the providers participating in the CEC Model. 

The CEC Beneficiary Performance Year RIF files contain PY finder files for the beneficiary population attributed to an ESRD Seamless Care Organization (ESCO).