Institutional

Institutional File, 2001-2006

Institutional Types

The Institutional file is a quarterly published file that contains a list of all providers currently certified in the CMS OSCAR system that are classified as belonging to one of the following nine types of institutions:

• Intermediate Care Facilities/Mentally Retarded (ICF/MR)
• Long Term Hospitals
• Nursing Facilities (NF-Title 19)
• Psychiatric Hospitals
• Psychiatric Units
• Rehabilitation Hospitals
• Rehabilitation Units
• Skilled Nursing Facilities (SNF - Title 18 and Title 18/19)
• Swing Bed Hospitals

Demographic-only Institutional Payment Status

Generally, an enrollee in a Medicare Advantage plan who is under care or custody in one of the above nine types of certified institutions, (or certified parts of an institution where applicable), and, who has met appropriate residency requirements, qualifies for the institutional payment adjustment under the demographic-only method of payment.

Institutional Status Requirements

The details associated with the institutional payment are attached below in an excerpt, section 170, from the August 2004 version of Chapter 7, Payments, of the Managed Care Manual. This excerpt describes in detail the requirements of the institutional status. This section also carefully defines the nine types of qualifying institutions.

When Chapter 7 is updated the attached link will be updated also.

Please bear in mind that while institutional status is part of the Risk Adjustment payment method it nevertheless has a distinct meaning from institutional status in the demographic-only method. Furthermore the data systems identifying institutional status for the risk adjustment method are also different.

Duration of the Institutional Report

Consequently, this institutional report will be published as long as the demographic-only payment has relevance. The publication of the reports actually terminated earlier than the termination of the demographic-only payment method. The last published report, listed below, is for June 2006.

Quarterly Publication

The institutional report is published quarterly. Generally this means that the data is current in the OSCAR system within 15 days of the last day of the quarter. For example, the June 2005 institutional report contains data that was downloaded from the OSCAR system somewhere between June 15, 2005 and July 15, 2005.

Report Format

The institutional report is published as a

• Comma separated file, (csv), file, containing a national sheet with all providers in the country
• Excel, (xls) file, containing a national sheet as well as sheets for each regional office.

Because of restrictions on the number of files per web page, and also because of the size of these files, we are only releasing the (csv) files. However an excel version of the most recent file will always be up. The County name field is only found on the Regional office sheets in the excel file. However the national sheet, while not containing county names, contains city names. A detailed listing of fields is found in the next subsection of this document.

Fields of the Institutional Report

The institutional file contains the following fields in the following order. The comma delimited, csv, files do not contain headers to facilitate their import into access and other databases.

• Facility Type--- one of the nine types, listed in the Institution Type subsection of this document,
• PROVIDER NUMBER--the 6 digit provider number
• FACILITY NAME-- the name of the institution
• STREET ADDRESS
• CITY
• State
• Zip
• Area Code
• Phone Number
• RO--The country is divided into 10 regions numbered 1-10. Each region is overseen by a CMS office. The central office of CMS has its headquarters in Baltimore. The 10 Region are (1) New England, (2) New York, (3) Philadelphia, (4) Atlanta, (5) Chicago, (6) Kansas, (7) Dallas, (8) Denver, (9) San Francisco and (10) Seattle.  Each regional office oversees several states. For example the New York regional office oversees New York, New Jersey, Puerto Rico and the Virgin Islands.
• StCnty Code--the 5 character social security (not FIPS) codes for the state and county
• CntyName--The county name field is only found on the regional office sheets prior to 2004. The regional office sheets in turn are only found on the excel version of the file. This website only lists the excel format for the current period.However since 2004 the County name field is also found on the national sheet in the csv format.

File Naming Conventions

The current naming conventions of the individual csv files uses a InstMMYY.csv format where MM stands for the month of the year and YY stands for the last 2 digits of the year. For example, Inst0903.csv, would contain the September (9-th month) 2003 institutional report.

The old website had a naming convention referring to OPL54, Operational Policy Letter 54. The Operational Policy Letters were one vehicle of communicating policy prior to the Managed Care manual. OPL 54 contained information on the institutional status. This information is currently contained in Section 170 of the Payment chapter of the Managed Care Manual. Since the OPL letters have been phased out we have switched file naming format.