Tip: Flagging beneficiaries in D-SNP plans

Number

0166

Submitting Entity (SE)

Medicare and Medicaid

Add Date

Oct 3, 2024

Update Date

 

Update

Included in October 2024 Data Tips email

Description

How to identify Medicare members in D-SNP plans.

For data requesters who qualify to get Medicare Fee-for-service data through the Arkansas APCD, these rules can be used to identify Medicare beneficiaries who have Dual Eligible Special Needs Plans (D-SNPs). 

Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage plans for people who are eligible for both Medicare and Medicaid.

There is no clear flag identifying Medicare beneficiaries as D-SNPs. The following rules have to be applies to flag them.

Select beneficiaries with D-SNP contracts.

  1. Find D-SNP contracts

    Select * into #tmp_SNP_PLAN from [dbo].[MCR_PRTD_PLN_CHR] a inner join [dbo].[MCR_PRTD_Contract_Info] b on a.CONTRACT_ID = b.CONTRACT_ID and a.MYEAR = b.MYEAR and a.PLAN_ID = b.PLAN_ID where a.SNP_TYPE = 'D'
  2. Select Medicare beneficiaries who have D-SNP contracts.  Output the contract ID fields,  Dual Status fields, and HMO indicator fields.  Note, a contract ID field exists for each month on a Medicare beneficiary record.  The beneficiary records will have to be pivoted to ensure each month is accounted for. The table below contains the fields to include.

Code sample for January:

select a.[BENE_ID], a.[DUAL_STUS_CD_01], a.[PTC_CNTRCT_ID_01], a.[HMO_IND_01], b.FIDE_SNP, b.SNP_TYPE, a.[BENE_ENROLLMT_REF_YR], [MONTH] = '01' ,CONCAT(a.[MYEAR],'-01') as YEARMO INTO #tmp_DSNP_JANUARY FROM [dbo].[MCR_BEN_SUM] a inner join #tmp_SNP_PLAN b (from #1) on a.[PTC_CNTRCT_ID_01] = b.[CONTRACT_ID] and a.[BENE_ENROLLMT_REF_YR] = b.[BENE_ENROLLMT_REF_YR] where (b.[FIDE_SNP] = 'Y' or b.[SNP_TYPE] = 'D') and b.PLAN_TYPE = '01' group by a.[BENE_ID], a.[DUAL_STUS_CD_01], a.[PTC_CNTRCT_ID_01], a.[HMO_IND_01], b.FIDE_SNP, b.SNP_TYPE, a.[BENE_ENROLLMT_REF_YR]
  1. Create a Member Month dataset for each month and then merge them into a single dataset.  Delete all records where the Dual Status Code = ('NA','09','99').  The remaining records represent Medicare beneficiaries with D-SNP plans by  month and year.

Active/Resolved

Active

Action / Resolution

 

Category 1

Medicare

Category 2

D-SNP

Tip / Issue

tip

HMO Indicator

 

Dual Status Code

Contract ID

[HMO_IND_01]

[DUAL_STUS_CD_01]

[PTC_CNTRCT_ID_01]

[HMO_IND_02]

[DUAL_STUS_CD_02]

[PTC_CNTRCT_ID_02]

[HMO_IND_03]

[DUAL_STUS_CD_03]

[PTC_CNTRCT_ID_03]

[HMO_IND_04]

[DUAL_STUS_CD_04]

[PTC_CNTRCT_ID_04]

[HMO_IND_05]

[DUAL_STUS_CD_05]

[PTC_CNTRCT_ID_05]

[HMO_IND_06]

[DUAL_STUS_CD_06]

[PTC_CNTRCT_ID_06]

[HMO_IND_07]

[DUAL_STUS_CD_07]

[PTC_CNTRCT_ID_07]

[HMO_IND_08]

[DUAL_STUS_CD_08]

[PTC_CNTRCT_ID_08]

[HMO_IND_09]

[DUAL_STUS_CD_09]

[PTC_CNTRCT_ID_09]

[HMO_IND_10]

[DUAL_STUS_CD_10]

[PTC_CNTRCT_ID_10]

[HMO_IND_11]

[DUAL_STUS_CD_11]

[PTC_CNTRCT_ID_11]

[HMO_IND_12]

[DUAL_STUS_CD_12]

[PTC_CNTRCT_ID_12]