Medicare

The KCC Model builds upon the earlier Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model structure, in which dialysis facilities, nephrologists, and other health care providers form ESRD-focused accountable care organizations to provide higher-quality, cost-effective care for beneficiaries with late-stage chronic kidney disease (CKD) and ESRD. CMS designed the KCC model to delay the onset of ESRD, better prepare patients for dialysis, coordinate care across different healthcare settings, and incentivize kidney transplantation.

What does this file include? (variable highlights)

• Participant Tax Identification Number
• Individual National Provider Identifier (NPI)
• CMS Certification Number
• KCC Model Participant Type
• Participant relationship to Kidney Contracting Entities under the KCC Model
• Participant information

Special Considerations

• This file can be linked to any other CMS file that includes the TIN, CCN, or NPI.
• The KCC Model Performance Period began on January 1, 2022, and will continue through December 31, 2027.
• For more information about the KCC Model, visit the CMS Innovation Center website or reference the CCW user guide. Questions about the model can be directed to [email protected].

The KCC Model builds upon the earlier Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model structure, in which dialysis facilities, nephrologists, and other health care providers form ESRD-focused accountable care organizations to provide higher-quality, cost-effective care for beneficiaries with late-stage chronic kidney disease (CKD) and ESRD. CMS designed the KCC model to delay the onset of ESRD, better prepare patients for dialysis, coordinate care across different healthcare settings, and incentivize kidney transplantation.

What does this file include? (variable highlights)

• Beneficiary ID
• Beneficiary Demographic Information
• Alignment Start Date
• Beneficiary Monthly Kidney Disease Status
• Beneficiary Monthly Eligibility Status

Special Considerations

• This file can be linked to any other CMS file that includes the Beneficiary ID.
• The KCC Model Performance Period began on January 1, 2022, and will continue through December 31, 2027.

For more information about the KCC Model, visit the CMS Innovation Center website or reference the CCW user guide. Questions about the model can be directed to [email protected].

This is an all-payer dataset completed for all patients receiving care in the LTCH including, but not limited to, Medicare Fee-for-Service (FFS) and Medicare Advantage beneficiaries and includes condition categories used to calculate scores for LTCH quality measure data.

LCDS assessment records are submitted to the Centers for Medicare & Medicaid Services (CMS) from all Medicare certified LTCHs in accordance with the data submission requirements identified in the Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) Manual.

What does this file include? (variable highlights)

• Beneficiary ID
• Beneficiary demographic information
• Facility provider identifiers and location
• Admission and discharge dates
• Beneficiary diagnoses, functional status and other physical status information
• Beneficiary cognitive pattern assessment
• Use of medications in high-risk drug classes
• Selected procedures, treatments and programs

Special Considerations

• For more information about the LCDS, please see the LCDS Manual on the CMS website.

What does this file include? (variable highlights)

• State, county annual SSA codes
• State, county monthly FIPS codes
• Zip code, State and County
• Date of birth, date of death
• Race
• Reason for entitlement
• Monthly enrollment for each part of the Medicare program, A/B/C/D
• Dual eligible status
• Part C plan and enrollment information
• Part D plan and enrollment information
• Part D low income cost sharing
• Social Security disability status variables

The AHC Research Identifiable File (RIF) contains beneficiary-level screening and navigation information about individuals participating in the AHC model. Participants included Medicare and Medicaid enrollees, 94% of whom can be linked to other CMS research files. The remaining 6% cannot be linked to Medicaid or Medicaid claims, since their Medicare and/or Medicaid ID was either missing or incomplete.

The file contains data for the entire AHC Model performance period, which began on May 1, 2017 and concluded on April 30, 2023. Screenings were conducted between May 1, 2018, and January 31, 2023, and navigation services were provided to those with at least one health-related social need (HRSN) and two or more emergency department (ED) visits between May 3, 2018, and April 30, 2023.

The file includes one record per beneficiary screening, with some beneficiaries having more than one screening. For each beneficiary, screening outcomes across domains (e.g. food, housing, safety, transportation, utilities) are reported. Some beneficiaries also have supplemental indicators related to disabilities, education, employment, family and community support, mental health, physical activity, and substance use. For screened items where a need is identified, the file contains information about services offered and their outcomes.

What does this file include? (variable highlights)

• Person level identifiers (i.e., BENE_ID, MSIS_ID) that researchers can use to link to other CMS research files
• Sociodemographic variables (e.g., date of birth, race and ethnicity, education, income)
• HRSN screening results (e.g., HRSNs reported, number of ED visits in the 12 months prior to screening)
• Navigation case information for those who were eligible and opted in to receive navigation (e.g., navigation case start and end dates)
• Contacts between navigator and beneficiary who received navigation services (e.g., total number of successful contacts during the navigation period)
• Navigation outcomes (e.g., beneficiary reported connection with a community service provider, beneficiary had their HRSN(s) resolved)

Special Considerations

Most beneficiaries (94%) in the file have been linked to an identifier (BENE_ID and/or MSIS_ID) that researchers can use to link to other CMS research files. For more information on how to use the data, please refer to the Accountable Health Communities (AHC) Model Data File User Guide.

This file contains CCS information submitted for the third through eleventh OCM performance periods (episodes initiating July 2, 2017 - December 31, 2021), primarily including data reported by OCM participants to the Oncology Care Model Registry (OCMR).

What does this file include? (variable highlights)

• Beneficiary ID
• ICD10 Cancer Diagnosis Code
• Initial Diagnosis Date
• Current Clinical Status coded into one of 10 categories
• Current Clinical Status Date

Special Considerations

• Many beneficiaries have multiple CCS records, within an episode and across multiple episodes.
• The Clinical and Staging data file and the Current Clinical Status data file can be linked by the Beneficiary ID, ICD10 Cancer Diagnosis Code Reported by Participant, and the Initial Diagnosis Date.
• Researchers may wish to obtain Medicare Fee-for-Service claims data for a population they identify within the OCM data files. The Beneficiary ID can be used to link to Medicare claims.

This file contains data for the third through eleventh OCM performance periods (episodes initiating July 2, 2017 - December 31, 2021), primarily including data reported by OCM participants to the Oncology Care Model Registry (OCMR).

What does this file include? (variable highlights)

• Beneficiary ID
• Episode Beginning Date
• Episode Ending Date
• OCM-Assigned Practice ID
• OCM-Assigned Cancer Type
• OCM 6-Month Episode Performance Period
• ICD10 Cancer Diagnosis Code
• Primary Tumor Staging
• Nodal Disease Staging
• Metastasis Staging
• Histology

Special Considerations

• There is one row per episode and beneficiaries can appear multiple times in the file depending on the number of 6-month episodes initiated.
• The Clinical and Staging data file and the Current Clinical Status data file can be linked by the Beneficiary ID, ICD10 Cancer Diagnosis Code Reported by Participant, and the Initial Diagnosis Date.
• The file does not include any treatment data such as surgery, radiation, hormonal therapy or chemotherapy. Researchers may wish to obtain Medicare claims data for a population they identify within the OCM data files. The Beneficiary ID can be used to link to Medicare claims.

Under OCM, physician practices entered into payment arrangements with CMS that included financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients. The practices which participated in OCM committed to providing enhanced services to Medicare beneficiaries such as care coordination, navigation, and adherence to national treatment guidelines for care.

OCM participants submitted staging and clinical data to the OCM Data Registry, a web-based data submission and collection tool, for their attributed episodes.

The data from the Oncology Care Model (OCM) is a set of two linkable files, which are both provided for a research request (i.e., cannot be requested separately):

• The Clinical and Staging file contains practice-reported staging and clinical data, which includes basic information on the episodes attributed to model participants.
• The Current Clinical Status file contains practice-reported, cancer-specific clinical and staging patient status values.

The data includes information about the care episodes, the practice ID to which they were attributed, episode beginning and end dates, and the clinical and staging characteristics.