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CMS Data Navigator Update

In the Centers for Medicare & Medicaid Services’ (CMS) continuing effort to keep you informed, we are sending you this listing of the recent data source additions to the CMS Data Navigator.

The most recent data release is for Shared Savings Program Accountable Care Organizations (SSP ACOs). The following are descriptions of the three file types, two of which are restricted use and one a downloadable PUF. These files will be available for each performance year of the program.

Please note that since the RIFs contain privacy protected information, we will only make them available to researchers who have a Data Use Agreement (DUA). Researchers interested in requesting these files will need to contact the Research Data Assistance Center (ResDAC).

Marketplace Data/Information

2015 Plan Selections by ZIP Code in the Health Insurance Marketplace

This dataset provides the total number of health plan selections by ZIP Code for the 37 states that use the HealthCare.gov platform, including the Federally-facilitated Marketplace, State Partnership Marketplaces and supported State-based Marketplaces. These data reflect the total number of consumers who selected a plan or were automatically re-enrolled for the 2015 coverage year as of January 16, 2015. This information is also available at Data.CMS.gov.

Note: This dataset does not include plan selections from the District of Columbia and 13 other states that have State-based Marketplaces.

Medical Loss Ratio Data and System Resources

The Affordable Care Act requires health insurance companies to disclose how much they spend on health care and how much they spend on administrative costs, such as salaries and marketing. If an insurance company spends less than 80% (85% in the large group market) of premium on medical care and efforts to improve the quality of care, they must refund the portion of premium that exceeded this limit. This rule is commonly known as the 80/20 rule or the Medical Loss Ratio (MLR) rule. CMS has released public use files with raw data for insurance companies subject to MLR reporting requirements. CMS has also released summary files that present a list of health insurers owing refunds as well as refunds by state and market.

Medicare & Medicaid Data/Information

Medicare Current Beneficiary Survey (MCBS) 2011 Cost and Use Files

CMS is pleased to announce the availability of the 2011 Cost and Use research files. The MCBS Cost and Use files link Medicare claims to survey-reported events and provides complete expenditure and source of payment data on all health care services, including those not covered by Medicare. First time MCBS users interested in these data need to contact CMS’ Research Data Assistance Center (ResDAC) to get more information about accessing MCBS data files. Current users, please contact ResDAC to update your current Data Use Agreement and for instructions regarding payment submission. For more information about the MCBS Cost and Use research files please visit the MCBS website.

September 2014 – Provider of Services (POS) Files

POS files are an invaluable resource for a variety of stakeholders, including researchers and application developers. These files contain data on the characteristics of hospitals and other types of healthcare facilities, including the name and address of the facility and the type of Medicare services the facility provides, among other information. The files contain an individual record for each Medicare-approved provider and are updated quarterly.

2013 Fiscal Year (FY) Payment Error Rate Measurement (PERM) Error Rate Findings and Reports

The PERM program measures improper payments in Medicaid and CHIP and produces error rates for each program. The error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of Medicaid and CHIP in the FY under review.

Community Mental Health Center (CMHC) Cost Reports

The data in this release includes years FY2010 to present. The CMHC Cost Report Data contains cost and statistical data for Community Mental Health Center providers.

Health Clinic Cost Reports

The data in this release includes years FY2009 to present. The Independent Rural Health Clinic and Freestanding Federally Qualified Health Center (HCLINIC) Cost Report Data contains cost and statistical data for Independent Rural Health Clinic and Freestanding Federally Qualified Health Center providers.

State Program Integrity Review Reports List

This is a comprehensive state program integrity (PI) review reports (& respective follow-up review reports) that provide CMS' assessment of the effectiveness of the State's PI efforts, including its compliance with Federal statutory & regulatory requirements.

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