Others titles
- US Counties Medicare Advantage Non PACE Risk Scores
- Medicare Advantage Non PACE Risk Scores By State And County
- Medicare Non PACE Adjusted Risk Scores By County
Keywords
- Non PACE Medicare Fees
- Non PACE Risk Scores
- Fee-for-Service Medicare Costs
- Medicare Payments
- Medicare Rates
- FFS Rates
- Medicare Risk Scores
- Medicare Risk Adjustment
- Advantage Payment Rates
- Non-PACE Rates
Medicare Advantage Non PACE Risk Score by County
The dataset contains information on the non-PACE (Programs of All-Inclusive Care for the Elderly) risk scores 2016-2020. Risk scores used in the ratebooks are calculated using the model to be used in the payment year. The beneficiaries included in the state-level risk scores in this dataset are those enrolled in fee-for-service (FFS) population.
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Description
Health plans that participate in the Medicare Advantage program receive monthly capitation payments for each Medicare enrollee. Each capitated payment is the product of two general parts: 1) A base rate which reflects the payment if a Medicare Advantage enrollee has the health status of the national average beneficiary, and 2) A risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiary. For each year, the raw (not normalized) risk scores were divided by the average risk score for that year to produce risk scores below which average out to 1.0. The purpose of the risk scores is to adjust Medicare Advantage payments so that they accurately reflect how much each Medicare Advantage enrollee would be expected to cost. Key components of the 2018 Medicare Advantage rates include: 1) Revision to the risk-adjustment model to better account for fully dual eligible beneficiaries. 2) Adjustment to certain measures within the Star Ratings program for socioeconomic status. 3) Update to the blended risk scores using 75 percent of the risk score calculated using data from the Risk Adjustment Processing System (RAPS) and 25 percent of the risk score calculated using encounter data. 4) Incentives to Medicare Advantage organizations to offer plans with lower maximum out-of-pocket limits.
The Programs of All-Inclusive Care for the Elderly (PACE) is a unique capitated managed care benefit for the frail elderly provided by a not-for-profit or public entity. The PACE program features a comprehensive medical and social service delivery system using an interdisciplinary team approach in an adult day health center that is supplemented by in-home and referral services in accordance with participants’ needs.
About this Dataset
Data Info
Date Created | 2016-04-04 |
---|---|
Last Modified | 2022-07-29 |
Version | 2022-07-29 |
Update Frequency |
Annual |
Temporal Coverage |
2016-2020 |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers for Medicare and Medicaid Services; |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | Non PACE Medicare Fees, Non PACE Risk Scores, Fee-for-Service Medicare Costs, Medicare Payments, Medicare Rates, FFS Rates, Medicare Risk Scores, Medicare Risk Adjustment, Advantage Payment Rates, Non-PACE Rates |
Other Titles | US Counties Medicare Advantage Non PACE Risk Scores, Medicare Advantage Non PACE Risk Scores By State And County, Medicare Non PACE Adjusted Risk Scores By County |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
County_FIPS_Code | The 5 digits county Federal Information Processing Standard (FIPS) code | string | - |
State | Name of state to which the beneficiary belongs | string | - |
County | Name of county to which the beneficiary belongs | string | - |
Risk_Score_2016 | Medicare advantage risk score for 2016; a risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiary | number | level : Ratio |
Risk_Score_2017 | Medicare advantage risk score for 2017; a risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiary | number | level : Ratio |
Risk_Score_2018 | Medicare advantage risk score for 2018; a risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiary | number | level : Ratio |
Risk_Score_2019 | Medicare advantage risk score for 2019; a risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiary | number | level : Ratio |
Risk_Score_2020 | Medicare advantage risk score for 2020; a risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiary | number | level : Ratio |
Data Preview
County FIPS Code | State | County | Risk Score 2016 | Risk Score 2017 | Risk Score 2018 | Risk Score 2019 | Risk Score 2020 |
1000 | ALABAMA | AUTAUGA | 0.937682 | 0.947973 | 0.961549 | 0.9645819999999999 | 0.940908 |
1010 | ALABAMA | BALDWIN | 0.936911 | 0.9534100000000001 | 0.954583 | 0.956642 | 0.9614659999999999 |
1020 | ALABAMA | BARBOUR | 0.990151 | 1.0177100000000001 | 0.98614 | 0.987196 | 0.991599 |
1030 | ALABAMA | BIBB | 0.949873 | 0.964498 | 1.0039959999999999 | 1.005547 | 1.032209 |
1040 | ALABAMA | BLOUNT | 0.9652959999999999 | 0.982324 | 0.9871340000000001 | 0.984302 | 1.007132 |
1050 | ALABAMA | BULLOCK | 0.954392 | 0.983347 | 0.9556100000000001 | 0.9832290000000001 | 0.9813629999999999 |
1060 | ALABAMA | BUTLER | 0.999582 | 0.992986 | 1.016634 | 1.0044110000000002 | 0.999509 |
1070 | ALABAMA | CALHOUN | 1.002704 | 1.023074 | 1.017568 | 1.019083 | 1.031405 |
1080 | ALABAMA | CHAMBERS | 0.981524 | 1.006329 | 0.989202 | 0.9966959999999999 | 1.002275 |
1090 | ALABAMA | CHEROKEE | 0.985935 | 0.99493 | 1.029399 | 0.9967219999999999 | 0.9924780000000001 |