The Medicare Master Beneficiary Summary File THE OLD AND NEW - - PowerPoint PPT Presentation

The Medicare Master Beneficiary Summary File

THE OLD AND NEW INFORMATION IT CONTAINS

Marshall McBean, M.D., M.Sc. Principle Investigator and Director, ResDAC Professor, University of Minnesota

Beneficiary-Level Part D Information

• Enrollment or “denominator” information – this

presentation

• Utilization or numerator information – later

presentations ˗ Prescription Drug Event (PDE) information ˗ “Characteristics” files

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Acronyms in this Presentation

• BSF – Beneficiary Summary File
• CCW – Chronic Condition Warehouse
• EDB – Enrollment Database
• RTI – Research Triangle Institute
• CAHPS - Consumer Assessment of Healthcare

Providers and System

• PDE – Prescription Drug Event
• QMB – Qualified Medicare Beneficiary

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Acronyms in this Presentation

• SLMB – Specified Low-income Medicare

Beneficiary

• QI – Qualifying Individuals
• QDWI – Qualified Disabled and Working

Individuals

• PACE – Program of All-Inclusive Care for the

Elderly

• LIS – Low Income Subsidy
• PDP – Prescription Drug Plan
• MA-PD – Medicare Advantage Prescription Drug

Plan

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History of Enrollment or “Denominator” Information for use in Part D studies

• Until recently there was a single Denominator File

created originally to work with Part A and Part B data; thin (80 columns), and we suggested that everyone get a copy of it for every study.

• Now different ‘denominator files’ may be

mentioned:

˗ The ‘old’ Denominator File is no longer available ˗ The Part D Denominator – short lived ˗ Beneficiary Summary File (BSF)– the next one ˗ Master Beneficiary Summary File (MBSF) -- this is it! (for now)

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Master Beneficiary Summary File

• There are 4 segments to the Master Beneficiary

Summary File

˗ Beneficiary Summary File or Medicare Enrollment (A/B/C/D information) ˗ Chronic Conditions ˗ Cost & Utilization ˗ NDI Death Information (includes ICD-10 Cause of Death) ; through 2008.

• This presentation is about the Beneficiary Summary

File (BSF) segment; sometimes shown as Part A/B or Part A/B/D Segments

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Beneficiary Summary File (BSF) Segment of the MBSF

• Similar to the traditional Medicare Denominator File

˗ 100% of all Medicare beneficiaries enrolled in that year ˗ Annual, calendar year file ˗ one record per beneficiary

• Information is what is known by CMS as of

12/31/20XX

• Traditional denominator information available by end
• f summer of 20XX+1 – in what is now called the

Beneficiary Summary File (BSF) segment of the MBSF

• “Part D denominator” information added in January or

February/March 20XX+2 , also, to the BSF segment of the MBSF

• So, you could have received the BSF segment for one

year in 1 or 2 pieces depending on when you request

• data. May not be true in 2013 and forward.

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Traditional Demographic and Enrollment Information in BSF Segment of MBSF

• Unique beneficiary identification number
• Demographics
• Medicare Part A, Part B, and Medicare Advantage

Plan enrollment information by month and annually

• Information about death

˗ Died during that year (yes/no) ˗ Date the person died

• Whether the beneficiary is in the 5% CCW random

sample or the enhanced 5% CCW random sample – Note: Part D data, unless otherwise specified in the Data Use Agreement (DUA) will be on the 5% samples

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Identification Number and Demographic Information

• A beneficiary identification number: encrypted

BENE_ID is unique to each Data Use Agreement (DUA); created by CCW/Buccaneer

• Date of birth and Age as of 12/31/20XX
• Gender
• Race/ethnicity – a one column field
• Place of residence – state, county and zip code

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Agreement Between Demographic Information in BSF and in Claims Files

• All demographic information in BSF and claims files

comes from the Enrollment Database (EDB) maintained at CMS Data Center

• As claims are processed, the demographic

information known to CMS at that time overwrites any demographic information in the claim

• Therefore, there is agreement between BSF and

claims unless change in status during the year – essentially talking about change in residency

• PDE File gender and date of birth variables from a

different source; therefore, recommend linking PDE and BSF for all demographic information.

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Residency in BSF

• State, county and ZIP code of residence are the

mailing address for official correspondence

• Some persons have their mail sent to another

person (e.g., son, daughter, guardian)

• Because residency in BSF is based on the

information available at the end of the calendar year, there may be some mismatch with residence

• n a claim from earlier in year.
• No residency variables in PDE or other Part D data

files.

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Traditional Enrollment Information

• Enrolled in Medicare Part A
• Enrolled in Medicare Part B
• “State buy-in” – did a state pay Medicare for

beneficiary’s Part B coverage in traditional Medicaid Program or in a Medicare Savings Program (QMB, SLMB, QI)

• Enrolled in Medicare Advantage (Part C); a.k.a.

managed care, HMO

A variable for each month and one indicting the total number of months enrolled in that year

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Medicare Savings Programs

• http://www.medicareinteractive.org/page2.php?t
• pic=counselor&page=script&slide_id=390 and

link to the individual state requirements

• New York state (see handout in this tab) -

http://www.health.ny.gov/health_care/medicaid/program /update/savingsprogram/medicaresavingsprogram.htm

• QMB – Qualified Medicare Beneficiary
• SLIMB – Specified Low-income Medicare

Beneficiary

• QI – Qualifying Individuals
• QDWI – Qualified Disabled and Working

Individuals

http://www.medicare.gov/publications/pubs/pdf/10126.pdf

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State Buy-in Variable Values

• 0 = NOT ENTITLED
• 1 = PART A ONLY
• 2 = PART B ONLY
• 3 = PART A AND PART B
• A = PART A, STATE BUY-IN
• B = PART B, STATE BUY-IN
• C = PARTS A AND B, STATE BUY-IN

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State Buy-In Indicator Values, June 2008

5% Sample, all ages State Buy-In Frequency Percent 0 = Not entitled (Why?) 126,068 4.82 1 = Part A only 164,463 6.28 2 = Part B only 3,826 0.15 3 = Part A and Part B 1,913,210 73.07 A = Part A, State Buy-in 58 0.00 B = Part B, State Buy-in 13,603 0.52 C = Parts A & B, State Buy-in 396,942 15.16

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How ResDAC Recommends You Use the State Buy-In Variable

• 1. Use it to select those with both Part A and Part

B coverage

˗ State Buy-in Variable values of “3” and “C” ˗ Do “all” of your studies on those who have both Part A and Part B coverage. ˗ Why? – see next slide

» Those with Part A only have lower rates of utilization (of hospitalization, e.g. » Not many beneficiaries with only Part B, and probably have different health utilization patterns

• 2. To identify those with less resources (will

discuss in Segments C and D of this workshop)

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Hospitalization rates by type of Medicare coverage (per 100 enrollees) supports the conclusion that persons with A-only coverage probably have incomplete claims, even for Part A services

5 10 15 20 25 30 35 65-74 75-84 85+

A+B A only

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Part D-related Denominator and Enrollment Information in the BSF Segment of the MBSF

• Types of information

˗ RTI race variable (RTI = Research Triangle Institute) ˗ Additional enrollment information ˗ Information for linking with the Part D Characteristics Files

• Enrollment information is presented in 2 different

ways

˗ For each month of the year; therefore, 12 variables ˗ Number of months (0-12), 1 variable

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Race – A One Column Variable

Hispanic ethnicity not asked nor coded separately

• Originally, race coded as:

˗ white, black, other, unknown

• Effective 1994, race codes were expanded to:

˗ white, black, Asian, Hispanic, Native American, other, unknown – the “old” race variable.

• New “RTI Race Code” variable is available in the

Beneficiary Summary File segment of the Master Beneficiary Summary File (The old race code information is available, also.) Was in the Part D sub-segment, but now in the Part A/B sub- segment.

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Traditional Medicare Race Variable

Accuracy and agreement between race variable in the Enrollment Database (EDB) and “SELFRACE”, self-reported race, from Medicare CAHPS Surveys of 2000 - 02

RACE/ Ethnicity Sensitivity Specificity Positive predictive value Kappa White 99.3 61.7 91.7 0.71 Black 97.4 98.8 86.3 0.91 Hispanic 29.5 99.9 92.7 0.43 Asian/P.I. 54.7 99.8 84.5 0.66

• Am. Indian/

Ak.Native 35.7 99.9 59.9 0.45 Other/Unk. 1.7 98.8 4.9 0.01

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Information Used in Algorithm

Improving the Identification of Hispanics and Asian/Pacific Islanders

• Language preference for materials requested from

CMS and Social Security Administration

• Source of the race/ethnicity code (survey, Indian

Health Service, other)

• State of residence (PR or HI)
• Hispanic and Asian/Pacific Islander surname lists

from U.S. Census Bureau

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Accuracy and Agreement Measures for RTI Race and EDB Race Compared with SELFRACE in the CAHPS Surveys

Race/ Ethnicity Sensitivity Specificity Positive predictive value Kappa Hispanic 79.2 29.5 99.7 99.9 81.5 92.7 0.80 0.43 Asian/PI 76.6 54.7 99.2 99.8 84.5 84.5 0.79 0.66

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Percentage Distribution of Medicare Enrollees by Race, 2008

BSF Race Code versus RTI Race Code

83.11% White 10.12% Black 1.84% Other 1.86% Asian 2.49% Hispanic 0.43% N America n Native 77.64% White 9.77% Black 1.19% Other 2.43% Asian/Pl 7.80% Hispanic 0.42% American Indian/Alask a Native

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Part D-Related Enrollment Information

• Encrypted Plan Contract ID – very important; next

˗

• ccurs 12 times

˗ unique to each plan ˗ tells what type of plan: MA-PD or PDP

• Cost Share Group (occurs 12 times) – information

about low income subsidy

• State Reported Dual Eligible Status Code (occurs 12

times)

• Beneficiary Dual Status Eligibility Months (0-12)
• On/Off Creditable Coverage Switch - little use
• Retiree Drug Subsidy Indicators (occurs 12 times) and

number of months – little use

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Encrypted Plan Contract ID Variable Name = PTD_CONTRACT_ID

Values for 1st column of 5 column variable

• H: local MA-PD, PACE*, Cost Plans and

Demonstrations; have PDE data

• R: Regional MA-PD; have PDE data
• S: PDP (prescription drug plan); have PDE data
• N: Not Part D enrolled; No data
• E: Employee-sponsored plans (beginning in 2007);

have PDE data; But most often do not have Plan Characteristics Data; historically, very few plans/beneficiaires, but the number increasing

• * PACE = Program of All-Inclusive Care for the Elderly;

see http://www.medicare.gov/publications/pubs/pdf/11341.pdf

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Percent Distribution of PTD_CONTRACT_ID

June 2008, 5% Sample, all ages

First Column of PTD_CONTRACT_ID Percent

0 - Not enrolled in Medicare that month 4.8 N – Not Part D enrolled 40.4 H - Local MA-PD 17.2 R – Regional MA-PD 0.6 S – PDP 36.7 E – Employer-sponsored plan 0.3

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“Extra help” – Low Income Subsidy (LIS)

• Benefits

˗ Help paying Medicare drug plan’s monthly premium, any yearly deductible, coinsurance, and/or copayments ˗ No coverage gap liability ˗ No late enrollment penalty

• Major Effort on the part of CMS and advocacy

groups to inform beneficiaries about the Low Income Subsidy available to them to help pay for Part D services.

• Low Income Subsidy (LIS) only relates to Part D

services, but this information is known for all beneficiaries

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“Extra Help” – Low Income Subsidy - Repeat

• Repeat: Major Effort on the part of CMS and advocacy

groups to inform beneficiaries with incomes and/or assets above levels that would qualify them for the above programs about the subsidy(ies) available to beneficiaries to help pay for Part D services

• Medicare & You 2013 -

http://www.medicare.gov/pubs/pdf/10050.pdf

• National Council on Aging -

http://www.ncoa.org/assets/files/pdf/center-for- benefits/part-d-lis-eligibility-and-coverage.pdf

• http://www.ncoa.org/assets/files/pdf/center-for-

benefits/part-d-lis-eligibility-and-benefits-chart.pdf

• See handout at end of this tab for next 2 slides

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10% 14% 13% 3% 17% 4% 21% 17%

Medicare Part D Enrollment, 2010

No creditable coverage Primary coverage through FEHB, TRICARE, or active worker Covered by employers who receive RDS Other creditable coverage Non-LIS in MA-PD LIS in MA-PD Non-LIS in PDP LIS in PDP

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The Variable that Describes the Low Income is the Cost Share Group Variable

Values for Cost Share Group variable

00 = Not Medicare enrolled for the month XX = Enrolled in Medicare A and/or B, but no MIIR record for the month Enrolled in Medicare A and/or B and enrolled in Part D and: 01 = Bene is deemed with 100% premium-subsidy and no copayment 02 = Bene is deemed with 100% premium-subsidy and low copayment 03 = Bene is deemed with 100% premium-subsidy and high copayment 04 = Bene with LIS, 100% premium-subsidy and high copayment 05 = Bene with LIS, 100% premium-subsidy and 15% copayment 06 = Bene with LIS, 75% premium-subsidy and 15% copayment 07 = Bene with LIS, 50% premium-subsidy and 15% copayment 08 = Bene with LIS, 25% premium-subsidy and 15% copayment 09 = No premium subsidy nor cost sharing = not LIS 10 -13 = not in Part D

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Frequency of Cost Share Group Values Among All Medicare Beneficiaries

June, 2008, 5% Sample

Cost Share Group Frequency Percent 00 = Not Medicare enrolled for the month 126,016 4.81 01 = Bene deemed; 100% premium subsidy; no copayment 68,521 2.62 02 = Bene deemed; 100% premium subsidy; low copayment 273,292 10.44 03 = Bene deemed; 100% premium subsidy; high copayment 112,178 4.28 04 = Bene with LIS; 100% premium subsidy; high copayment 55,327 2.11 05 = Bene with LIS; 100% premium subsidy; 15% copayment 5,341 0.20 06 = Bene with LIS; 75% premium subsidy; 15% copayment 6,419 0.25 07 = Bene with LIS; 50% premium subsidy; 15% copayment 6,230 0.24 08 = Bene with LIS; 25% premium subsidy; 15% copayment 5,002 0.19 09 = Not LIS, but in Part D 901,153 34.42 10 = Not Part D 367,827 14.05 11 = Not Part D 313,768 11.98 12 = Not Part D 375,206 14.33 XX = Enrolled in Medicare A &/or B; no MIIR record for month 1,890 0.07

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Summary: LIS and Non-LIS Beneficiaries in Medicare Population

June 2008

Percent of Total Medicare Population Percent of Part D Enrollees Enrolled in Part D 54.8 100 Low Income Subsidy (LIS) 20.3 37.1 Deemed to be LIS 17.3 31.7 Not deemed; therefore, applied for LIS 3.0 5.5

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Frequency of Cost Share Group Values

June 2008, 5% Sample, All Ages

Cost Share Group Frequency Percent of LIS 01 = Bene deemed; 100% premium subsidy; no copayment 68,521 12.87 02 = Bene deemed; 100% premium subsidy; low copayment 273,292 51.34 03 = Bene deemed; 100% premium subsidy; high copayment 112,178 21.07 04 = Bene with LIS; 100% premium subsidy; high copayment 55,327 10.39 05 = Bene with LIS; 100% premium subsidy; 15% copayment 5,341 1.00 06 = Bene with LIS; 75% premium subsidy; 15% copayment 6,419 1.21 07 = Bene with LIS; 50% premium subsidy; 15% copayment 6,230 1.17 08 = Bene with LIS; 25% premium subsidy; 15% copayment 5,002 0.94

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Percent Distribution of LIS Beneficiaries, June 2008

PS = Premium Subsidy

12.9 51.3 21.1 10.4 1.0 1.2 1.2 0.9

Deemed; 100% PS; no copay Deemed; 100% PS; low copay Deemed; 100% PS; high copay Other LIS; 100% PS; high copay Other LIS; 100% PS; 15% copay Other LIS; 75% PS; 15% copay Other LIS; 50% PS; 15% copay Other LIS; 25% PS; 15% copay

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Collapsed Values for Cost Share Group Variable

• Those who receive Low Income Subsidy (LIS)

˗ Deemed eligible (01, 02, 03) ˗ Those who apply for LIS (04, 05, 06, 07, 08)

• How useful is this information?

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Percent Distribution of LIS Beneficiaries, June 2008

Deemed (85.3%) Other LIS (14.7%)

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State Reported Dual Status Eligible Code Variable

• Occurs 12 times
• Can finally tell who has “traditional Medicaid”

versus one of the Medicare Savings Programs (QMB, SLMB, QI, QDWI).

• As described earlier, formerly, the Medicare

Denominator File and the BSF only had a “State buy-in” variable that lumped together Medicaid recipients and those in Medicare Savings Programs (QMB, SLMB, QI, QDWI).

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State Reported Dual Eligible Status Code Variable Values

• 00 = Not Medicare enrolled for the month
• XX = Enrolled in Medicare A and/or B, but no MIIR record for

the month

• NA = Non-Medicaid
• 01 = QMB only
• 02 = QMB and Medicaid coverage including RX
• 03 = SLMB only
• 04 = SLMB and Medicaid coverage including RX
• 05 = QDWI
• 06 = Qualified Individuals
• 08 = Other Dual Eligibles (Non-QMB, SLMB, QWDI, or QI)

w/Medicaid coverage including RX

• 09 = Other Dual Eligibles but without Medicaid coverage
• 99 = Unknown

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State Reported Dual Status Eligible Code Variable

JUNE 2008, 5% sample, all ages

Frequency Percent 00 = Not Medicare enrolled that month 126,016 4.81 01 = QMB only 44,594 1.70 02 = QMB + Medicaid coverage inc. Rx 238,071 9.09 03 = SLMB only 33,604 1.28 04 = SLMB + Medicaid coverage inc. Rx 11,846 0.45 05 = QDWI <11 0.00 06 = Qualified individuals 19,057 0.73 08 = Other Dual Eligibles (non-QMB, SLMB, QDWI or QI) 83,447 3.19 09 = Other duals without Medicaid coverage 14,403 0.55 99 = Unknown 17 0.00 NA = Non Medicaid 2,045,220 78.12 XX = Enrolled in A and/or B, no MIIR record 1,890 0.07

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• 01 = QMB only
• 02 = QMB and Medicaid coverage including RX
• 03 = SLMB only
• 04 = SLMB and Medicaid coverage including RX
• 05 = QDWI
• 06 = Qualified Individuals
• 08 = Other Dual Eligibles (Non-QMB, SLMB, QWDI, or

QI) w/Medicaid coverage including RX

• 09 = Other Dual Eligibles but without Medicaid

coverage

Dual Eligible Medicare and Medicaid Beneficiaries -- Discuss

So, who are the duals?

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Full Duals, Partial Duals, And to be Decided

• 01 = QMB only
• 02 = QMB and Medicaid coverage including RX
• 03 = SLMB only
• 04 = SLMB and Medicaid coverage including RX
• 05 = QDWI
• 06 = Qualified Individuals
• 08 = Other Dual Eligibles (Non-QMB, SLMB, QWDI,
• r QI) w/Medicaid coverage including RX
• 09 = Other Dual Eligibles but without Medicaid

coverage

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Full Duals, Partial Duals, Undecided, and Others

June 2008, 5% Sample, All Ages

Frequency Percent 00 = Not Medicare enrolled that month 126,016 4.81 01 = QMB only 44,594 1.70 02 = QMB + Medicaid coverage inc. Rx 238,071 9.09 03 = SLMB only 33,604 1.28 04 = SLMB + Medicaid coverage inc. Rx 11,846 0.45 05 = QDWI <11 0.00 06 = Qualified individuals 19,057 0.73 08 = Other Dual Eligibles (non-QMB, SLMB, QDWI or QI) 83,447 3.19 09 = Other duals without Medicaid coverage 14,403 0.55 99 = Unknown 17 0.00 NA = Non Medicaid 2,045,220 78.12 XX = Enrolled in A and/or B, no MIIR record 1,890 0.07

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Full Duals, Partial Duals, and Undecided

June 2008, 5% Sample, All Ages

Frequency Percent of Duals Full Duals 333,364 74.9 Partial Duals 97,255 21.8 Undecided 14,403 3.2

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Additional Variable in BSF Segment of MBSF Beneficiary Dual Status Eligibility Months

• Sum of the monthly State Reported Dual

Eligible Status Code codes 01 through 09

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Linking with the Characteristics Files

• 3 variables in BSF segment of MBSF used to link to the

Characteristics Files:

˗ Encrypted Contract ID ˗ Encrypted Plan Benefit Package ID ˗ Encrypted Segment (market area) ID

• The Characteristics Files will be explained later in

Workshop

˗ Plan Characteristics File ˗ Provider (Pharmacy) Characteristics File ˗ Prescriber Characteristics File ˗ Drug Characteristics File (actually appended to the PDE file)

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