Tip: Flagging beneficiaries in D-SNP plans

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Medicare and Medicaid

Oct 3, 2024

Included in October 2024 Data Tips email

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:

3. 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.

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