All MA-PD plans, 1876 Cost Plans, PACE organizations, and PDPs. Subject: Incoming File from CMS: Beneficiary-level file to support 2015 Part D bids
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1 DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland CENTER FOR MEDICARE Date: April 11, 2014 To: All MA-PD plans, 1876 Cost Plans, PACE organizations, and PDPs From: Cheri Rice, Director Medicare Plan Payment Group Subject: Incoming File from CMS: Beneficiary-level file to support 2015 Part D bids CMS has pushed out to all MA-PD plans, 1876 Cost Plans, PACE organizations, and PDPs a beneficiary-level file that your actuaries will be using to develop 2015 Part D bids. This memo is to inform you that there may be potential action that is needed for you to accept this new file. Please also note that we posted contract-pbp level risk score data on HPMS. The file name will be constructed as follows: GENTRAN: P.Rxxxxx.PRTD2015.Dyymmdd.Thhmmsst.pn C:D mainframe: zzzzzzzz.rxxxxx.prtd2015.dyymmdd.thhmmsst C:D non-mainframe: [directory]rxxxxx.prtd2015.dyymmdd.thhmmsst KEY xxxxx = 5 character plan contract yymmdd = two digit year, month, day hhmmsst = hour/minute/second/tenths of second pn = process number zzzzzzzz = Plan-provided high level qualifier, default is EFTO for production; EFTT for test [directory] = optional directory specified from non-mainframe C:D clients, default is EFTO. for production; EFTT. for test If you have any questions regarding the retrieval of this file, please contact the MAPD Help Desk via at MAPDHELP@cms.hhs.gov or via phone at If you have questions about the content of the file, please the CMS Risk Adjustment mailbox at RiskAdjustment@cms.hhs.gov and specify Payment Year 2015 Risk Scores for Bidding in the subject line. Below is the file layout with technical notes. 1
2 Tech Notes Please note the following: 1. The file includes beneficiaries who were in your contract for at least one month in The risk scores provided in this file are not normalized and your projected 2015 risk score will need to take into account the appropriate normalization factor, per the 2015 Bid Instructions. The 2015 Part D normalization factor is The estimated 2013 risk score takes into account retroactive (1) enrollment and disenrollment, (2) long term institutional status, and (3) low income status that have occurred since the 2013 payments were initially made. The diagnosis data used for the risk score estimates are from calendar year 20 dates of service (i.e., the data collection period) based on: 1) plan diagnosis data submitted through January 31, 2014 and 2) Medicare FFS diagnosis data through January Final 2013 risk scores will use the same runout for plan-reported diagnoses; approximately one more month of FFS diagnostic runout; as well as any additional status changes that occur before the final risk score run (e.g., low income, long term institutional, disability, ESRD). 5. The 2013 Part D risk scores were calculated using both the RxHCC risk adjustment that was used in 2013 payment and the RxHCC risk adjustment that will be used in 2015 payment. The RxHCC that will be used in 2015 payment is the same RxHCC used for payment in The coefficients for the 2013 are published in the 2013 Rate Announcement, published on April 2, 20. The coefficients for the 2015 (which is the same as the used in 2014) are published in the 2014 Rate Announcement, published on April 1, File layout & data dictionary Part D risk scores Field 1 CAN/BIC 1- Beneficiary ID A beneficiary is on the file as long as they were in the Part D contract for at least one month in Contract ID 5 X Contract ID. Array of monthly fields. Contract ID is populated for those months in the payment year for which the beneficiary was enrolled in the contract. For each month that this field is populated, the other applicable monthly fields are appropriately populated for the beneficiary. If this field is blank, then the beneficiary was not enrolled in the contract for the month in question Plan ID 3 X 73- Plan ID. Array of monthly PBP in which the beneficiary is 2
3 26-37 Segment ID 3 X 38 Part D new LI/ Part D new enrollee LI/ Part D new Part D new 42 Part D new enrollee 43 Part D new ESRD risk 44 Part D LTI Part D LI aged Part D non-li aged risk 47 Part D LI 48 Part D non-li 108 fields. enrolled for the month Segment ID. Array of 144 monthly fields LI/ risk RxHCC. enrollee LI/ 2014 RxHCC. risk RxHCC. LI/ESRD 2014 RxHCC. enrollee LI/ESRD 2014 RxHCC. ESRD 2014 RxHCC. risk LTI 2014 RxHCC. risk aged/li 2014 RxHCC. risk aged/non-li 2014 RxHCC. risk disabled/li 2014 RxHCC. risk disabled/non-li 2014 RxHCC. 49 Part D new Segment in which the beneficiary is enrolled for the month. MA-PDs only.
4 LI/ Part D new enrollee LI/ Part D new Part D new 53 Part D new enrollee 54 Part D new ESRD risk 55 Part D LTI Part D LI aged Part D non-li aged risk 58 Part D LI 59 Part D non-li Part D Beneficiary status X 228 LI/ risk RxHCC enrollee LI/ 2013 RxHCC. risk RxHCC. LI/ESRD 2013 RxHCC. enrollee LI/ESRD 2013 RxHCC. ESRD 2013 RxHCC. risk LTI 2013 RxHCC. risk aged/li 2013 RxHCC. risk aged/non-li 2013 RxHCC. risk disabled/li 2013 RxHCC. risk disabled/non-li 2013 RxHCC. Array of monthly flags. Part D Beneficiary status codes are as follows: 1 = New Enrollee Institutional 4
5 72-83 Part D ESRD status 1 X 2 = New Enrollee Low Income 3 = New Enrollee Non-Low Income 4 = Continuous Enrollment Institutional 5 = Continuous Enrollment Low Income Aged 6 = Continuous Enrollment Non- Low Income Aged 7 = Continuous Enrollment Low Income Disabled 8 = Continuous Enrollment Non- Low Income Disabled Array of monthly flags Part D ESRD status codes are as follows: 1 = Not ESRD 2 = ESRD There is an ESRD add-on in the new enrollee risk scores in the risk adjustment. These flags are for MA-PDs and PDPs to use in assessing the new enrollee risk score. 5
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