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Data Source TitleDescriptionINCLD_IN_HLTH_DATA_SWPopularityModified OnApproved OnDocument TypeProgramSetting/Type of CareGeographyTopicData Source URLRequires DUAStatus
ACA Risk Adjustment - Overview, Context, and ChallengesVolume 4, Issue 3 of the Medicare and Medicaid Research Review includes three articles describing the Department of Health and Human Services (HHS) developed risk adjustment methodology under the Affordable Care Act (ACA). The ACA provides for a program of risk adjustment in the individual and small group markets using the HHS risk adjustment methodology, so as to compensate health insurance plans for differences in enrollee health mix so plan premiums reflect differences in scope of coverage and other plan factors, but not differences in health status. The methodology includes a risk adjustment model and a risk transfer formula. The article, Affordable Care Act Risk Adjustment - Overview, Context, and Challenges, describes the key program goal and issues in the HHS developed risk adjustment methodology and identifies key choices in how it responds to these issues, while The HHS-HCC Risk Adjustment Model for Individual and Small Group Markets under the Affordable Care Act, estimates differences in health risks taking into account the new population and scope of coverage. Risk Transfer Formula for Individual and Small Group Markets under the Affordable Care Act, describes how the transfer formula calculates balanced transfers intended to account for health risk differences while preserving permissible premium differences.5779/9/2014 8:33:49 AM9/9/2014 8:33:49 AMPublicationsMedicaid-Expansion, Medicare Advantage, Health Insurance MarketplacePhysician Services, Hospital, Inpatient, Outpatient, Part DNationalQuality, Claims, Covered Services, Eligibility, Enrollment, Expenditures, Paymentshttp://www.cms.gov/mmrr/Articles/A2014/MMRR2014_004_03_a02.htmlNoActive
Access to Care Issues Among Qualified Medicare Benes (QMB)This report contains two studies to assess access to care for Qualified Medicare Beneficiaries (i.e., QMB enrollees). The first study entails qualitative interviews with beneficiaries to better understand access to care among QMB enrollees and whether QMB enrollees are inappropriately balance billed (charged the cost-sharing on Medicare-covered services). The second study investigated whether there is an association between state policies on reimbursement to providers for Medicare cost-sharing and QMB health service utilization. 812/6/2017 2:47:13 PM12/6/2017 2:47:13 PMReportsMedicare-Medicaid Dual Beneficiaries, Medicaid, MedicarePhysician Services Research, Access to Care, Payments, Persons Servedhttps://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/QMB.htmlNoActive
Accounting for Unobservable Exposure Time Bias Wh...Accounting for Unobservable Exposure Time Bias When Using Medicare Prescription Drug Data Unobservable exposure time is common among Medicare Part D beneficiaries, and they are often in worse health. To retain patients with unobservable exposure time, we recommend stratifying patients on receipt of post-acute facility-based care, calculating and using observable days as a covariate and, when appropriate, using the discharge date from contiguous post-acute facility care for beginning the exposure assessment period.911/20/2013 8:23:17 AM11/20/2013 8:23:17 AMPublicationsMedicareAcute Care Hospital, Hospital, Inpatient, Part D, Pharmacy, Skilled Nursing (SNF), Nursing Home, Psychiatric Facility, Long Term Care (LTC)NationalPrescription Drugshttp://www.cms.gov/mmrr/Articles/A2013/MMRR2013_003_04_a01.htmlNoActive
Actuarial StudiesThe Office of the Actuary in the Centers for Medicare and Medicaid Services (CMS) from time to time conducts studies on various aspects of the Medicare and Medicaid programs. The available studies include the following- Medicare Financial Status, Budget Impact, and Sustainability-Which Concept is Which, Actuarial Report on the Financial Outlook for Medicaid, Estimated Impact of Health Care Reform Proposals, Analysis of volume-and-intensity response to a price change for physicians services, Analysis of expenses in the last year of life.1025410/3/2018 1:28:07 PM10/3/2018 1:28:07 PMReports, StatisticsMedicaidLong Term Care (LTC)NationalTrends, Budget, Enrollment, Expenditures, Paymentshttp://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/NoActive
Acute Inpatient PPS Final Rule Data FilesBelow are the data files and impact file for the FY 2015 final Rule. The tables for the FY 2015 final rule are located on a separate list.17526/12/2018 2:37:24 PM6/12/2018 2:37:24 PMPublicly Available Data File - for downloadMedicareAcute Care Hospital, Hospital, Inpatient, ProvidersCounty, National, Regional, StateProspective Payment System (PPS), Diagnosis Related Grouping (DRG)https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.htmlNoActive
Acute Inpatient PPS Final Rule Data Files - 2011Below are the data files and impact file for the FY 2011 Final Rule. The tables for the FY 2011 final rule are located on a separate list.8136/12/2018 2:39:01 PM6/12/2018 2:39:01 PMPublicly Available Data File - for downloadMedicareAcute Care Hospital, Hospital, Inpatient, ProvidersCounty, National, Regional, StateProspective Payment System (PPS)http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY-2011-IPPS-Final-Rule-Home-Page-Items/CMS1237932.htmlNoInactive
Acute Inpatient PPS Final Rule Data Files - 2012Below are the data files and impact file for the FY 2012 Final Rule. The tables for the FY 2012 final rule are located on a separate list.1336/12/2018 2:39:13 PM6/12/2018 2:39:13 PMPublicly Available Data File - for downloadMedicareAcute Care Hospital, Hospital, Inpatient, ProvidersCounty, National, Regional, StateProspective Payment System (PPS)http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY-2012-IPPS-Final-Rule-Home-Page-Items/CMS1250507.htmlNoInactive
Acute Inpatient PPS Final Rule Data Files - 2014Below are the data files and impact file for the FY 2014 Final Rule. The tables for the FY 2014 final rule are located on a separate list.6096/12/2018 2:38:43 PM6/12/2018 2:38:43 PMPublicly Available Data File - for downloadMedicareAcute Care Hospital, Hospital, Inpatient, ProvidersCounty, National, Regional, StateReadmissions, Prospective Payment System (PPS), Diagnosis Related Grouping (DRG)http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY-2014-IPPS-Final-Rule-Home-Page-Items/FY-2014-IPPS-Final-Rule-CMS-1599-F-Data-Files.htmlNoInactive
Acute IPPS - Direct Graduate Medical Education (DGME)Section 1886(h) of the Act, establish a methodology for determining payments to hospitals for the costs of approved graduate medical education (GME) programs.65531/6/2016 9:56:40 AM1/6/2016 9:56:40 AMStatisticsMedicare NationalPayments, Prospective Payment System (PPS), Surveyhttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dgme.htmlNoActive
Acute IPPS - Disproportionate Share Hospital - DSHThere are two methods for a hospital to qualify for the Medicare DSH adjustment. The primary method is for a hospital to qualify based on a statutory formula that results in the DSH patient percentage. The DSH patient percentage is equal to the sum of the percentage of Medicare inpatient days attributable to patients eligible for both Medicare Part A and Supplemental Security Income (SSI), and the percentage of total inpatient days attributable to patients eligible for Medicaid by not Medicare Part A.295911/6/2016 9:09:09 AM1/6/2016 9:09:09 AMStatisticsMedicare, Medicare AdvantageHospital, Inpatient, Part A, Providers, Part C, Disproportionate Share Hospitals (DSH)National, RegionalResearch, Claims, Eligibility, Enrollment, Payments, Prospective Payment System (PPS)http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dsh.htmlNoActive
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