PBP cardiac pulmonary rehab (cleaned view)

What it is

1. 1A source-faithful, agent-ready view of Medicare Advantage member cost-sharing (copay / coinsurance, plus prior-auth and referral flags) for cardiac and pulmonary rehabilitation benefits, unpacked from the CMS PBP (Plan Benefit Package) PUF Section B3 across quarterly snapshots from 2019 through 2026; it answers 'what does each MA plan charge for cardiac/pulmonary rehab and is auth/referral required'.

Grain

How to read it

1. 1To get the in-network cardiac-rehab cost share for a plan in the current plan year, filter to one snapshot and one sub-benefit, e.g.
2. 2SELECT contract_id, plan_id, segment_id, cost_share_string, copay_amount, coinsurance_pct, auth_required FROM vw_pbp_cardiac_pulmonary_rehab WHERE report_year=2026 AND quarter=1 AND rehab_sub_benefit='cardiac_rehab_basic'.
3. 3This returns each plan's filed member copay/coinsurance and whether prior auth is needed for standard cardiac rehab.
4. 4To compare the four rehab types for one plan, drop the sub_benefit filter and you get 4 rows.

Traps

1. 1No single ID column is unique. contract_id (1,231), plan_id (656), segment_id (24) are all repeated. The profiler's suggested candidate key (contract/plan/segment + limit_period_code + benefit_amount_period_code + confidence_tier) is WRONG — those three extra columns are 100% NULL or constant. The true key MUST include report_year, quarter, AND rehab_sub_benefit.
2. 2Pick ONE snapshot or you will multiply rows. There are 16 (report_year, quarter) snapshots from 2019-2026; without a report_year+quarter filter a plan appears many times across years. 'quarter' is the CMS PUF release quarter, not a coverage period.
3. 3Each plan-snapshot is fanned into 4 rows (one per rehab sub-benefit: cardiac_rehab_basic / intensive_cardiac_rehab / pulmonary_rehab / setpad). rehab_sub_benefit and source_pbp_section are 1:1 (B3_CRS/B3_ICRS/B3_PRS/B3_SETPAD). Filter on rehab_sub_benefit when you want a single benefit, else you 4x your aggregates.
4. 4offered_status is a constant 'offered' scaffolding value and does NOT mean the plan offers that sub-benefit. ~20,880 rows are actually not-offered: detect them by cost_share_string IS NULL / auth_required IS NULL (these also have has_copay/has_coinsurance/has_deductible = NULL), not by offered_status.
5. 5All benefit-amount and limit columns are 100% NULL (benefit_amount, benefit_amount_pmpm, benefit_amount_annualized, limit_text, limit_quantity, limit_period_code, normalization_status, aggregation_policy, etc.). They are shared-schema scaffolding; the gold metadata constants explain it: numeric_amount_observability='offered_without_numeric_amounts', null_amount_reason='unknown_requires_crosswalk', confidence_tier='source_faithful'. Use cost_share_string / copay_amount / coinsurance_pct for the actual cost share.
6. 6source_url and sha256_content_hash are snapshot-level provenance (exactly 16 distinct, one per year+quarter), NOT row identifiers. has_deductible is never true. copay vs coinsurance are near-mutually-exclusive (plans file one or the other). The min/max copay & coinsurance columns just mirror the single value here.

Columns (64)

Query it

describe_data_source(source_fqn="medicare_semantic.vw_pbp_cardiac_pulmonary_rehab")     # the card, live
query_substrate(sql="SELECT * FROM medicare_semantic.vw_pbp_cardiac_pulmonary_rehab WHERE contract_id = '<value>' AND plan_id = '<value>' AND segment_id = '<value>' AND report_year = '<value>' AND quarter = '<value>' AND rehab_sub_benefit = '<value>' LIMIT 100")