Plan Characteristics File

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

The subfiles are:

  • Plan “Base” or Benefit package file
  • Premium
  • Cost Sharing Tier
  • Service Area
  • Special Needs Plans
  • Multi-year crosswalk file

What does this file include? (variable highlights)

  • Initial and gap coverage limits
  • Plan premium amount
  • Plan service area description
  • Crosswalk of current plan ID to previous years
  • Demonstration type
  • Special needs plan type
  • Linkage variables to the PDE and to each of the Plan Characteristic File sub-files:
    • Plan Contract ID, Plan Benefit Package ID (use in combination to link to specific plan)

Why do researchers request this file?

  • Studies that compare medication usage and clinical outcomes by plan benefits

Special considerations

  • Plan identifiers are encrypted in the data prior to the CY2015 file, so researchers must use this file to find out more information about the plan. Beginning with the CY2015 file, plan contract ID numbers are not encrypted
  • This file consists of six sub-files.
  • When the Plan characteristics file is requested and approved, all subfiles are delivered.

Long Term Care Minimum Data Set (MDS) 3.0

The Long Term Care Minimum Data Set (MDS) is a health status screening and assessment tool used for all residents of long term care nursing facilities certified to participate in Medicare or Medicaid, regardless of payer. The assessment is also required for Medicare payment of skilled nursing facility stays. Assessment data for Skilled Nursing Swing Beds 3.0 is included in a separate file, MDS version 3.0 was implemented on October 1, 2010, replacing version 2.0.

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

Long Term Care Minimum Data Set (MDS) - Swing-Bed 3.0

The Long Term Care Minimum Data Set (MDS)-Swing Bed is a health status screening and assessment tool. It is required for Medicare payment of hospital-based skilled nursing care. Swing-bed providers are hospitals that can use their beds, as needed, to provide either acute or post-acute skilled nursing care.  The swing-bed assessment includes a subset of the skilled nursing facility (SNF) assessment items. The MDS 3.0 was implemented in October, 2010, replacing version 2.0.

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

MAX Personal Summary File

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.

What does this file include? (variable highlights)

  • Bene_ID (links to all other CMS Research Identifiable Files (RIF))
  • State, county, zipcode
  • Date of birth, gender, race
  • Eligibility category
  • Dual Medicare-Medicaid eligibility
  • Medicaid managed care enrollment
  • Summary utilization, Medicaid payments

Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) 2.0

The Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) 2.0 suite of files combines Medicare and Medicaid enrollment and claims data into four annual beneficiary-level files. The files include beneficiaries who are Medicare-only, Medicare-Medicaid dually enrolled and Medicaid-only blind and disabled.

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 Services file
    • Medicaid Services file
    • Conditions file

Special considerations

Background:

CMS has developed a new Medicaid DQ Atlas, an interactive, web-based tool that helps policymakers, analysts, researchers, and other stakeholders explore the quality and usability of the Medicaid TMSIS Analytic File (TAF). The charts, maps, and tables in the new DQ Atlas show state-level DQ assessments and associated measure values for topics that are pertinent to Medicaid and CHIP.

Year of Data:
Source:
CMS
Format:
Web Link
Download
Background:

This document describes the development and content of the TAF annual Demographic & Eligibility (DE) file. The TAF DE includes information on the demographic, eligibility, and enrollment characteristics of beneficiaries who were enrolled in Medicaid or in CHIP for at least one day during any given calendar year.

Year of Data:
Source:
CMS
Format:
Adobe PDF
Download
Background:

This document describes the development and content of the four claims files that contain service use and payment records: (1) the IP file includes institutional inpatient services and payments, (2) the LT file includes institutional long-term care services and payments, (3) the OT file includes all other medical services and payments, and (4) the RX file includes prescription drug fills and pharmacy payments.

Year of Data:
Source:
CMS
Format:
Adobe PDF
Download
Background:

This document provides instructions for analyzing claims data submitted by Illinois. This is a short-term solution that will help make the data usable until the state can implement changes to address this issue.

Year of Data:
Source:
CMS
Format:
Adobe PDF
Download

2019 Preliminary Medicaid and CHIP Data Now Available

CMS is pleased to announce the availability of Preliminary Medicaid T-MSIS Analytic Files (TAFs) for calendar year 2019. Beginning with 2019 data, CMS plans to release a “Preliminary” version of the TAF RIF for each service year to give TAF users earlier access to Medicaid data in the research file format. The Preliminary RIF data is not fully mature because states are still submitting service use records for that year, so users should be aware of this when planning their analytics.

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