ELG.011.163

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TMSIS Dataguide

Medicaid.gov

Version 3.38.0

STATE-PLAN-OPTION-TYPE

Data Element

DE Number

ELG163

System DE Number

ELG.011.163

File Name

File Segment Number

File Segment Name

STATE-PLAN-OPTION-PARTICIPATION

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	This field specifies the State Plan Options in which the individual is enrolled. Use on occurrence for each State Plan Option enrollment.
Size	X(2)
FLF Start Position	42
FLF Stop Position	43
Segment Key Field Identifier	3
Coding Requirements	1. Value must be in State Plan Option Type List (VVL) 2. If associated Eligibility Group (ELG.005.087) value is in [ "72", "73", "74", "75" ], and Restricted Benefits Code (ELG.DE.097) is "1" or "7", then value must be "06" 3. Value must be 2 characters 4. Mandatory 5. Value must equal "02" when Program Type (CIP.002.129) equals "13" 6. Value must equal "02" when Program Type (COT.002.065) equals "13"

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-1001	If the program type is HCBS State Plan Option 1915(i) on a non-denied claim from an LT file, then the waiver type value reported must be '2'.
RULE-1420	If a non-denied OT claim has a program type of (13) HCBS State Plan Option 1915(i), then the state plan option participation ELG file must have a state plan option type equal to '02'.
RULE-1815	If a non-denied RX claim has a program type of (13) HCBS State Plan Option 1915(i), then the state plan option participation ELG file must have a state plan option type equal to '02'.
RULE-2307	If the state plan option type is populated on a state plan option participation file, then the state plan option type reported must be found in the list of valid values.
RULE-562	If a non-denied IP claim has a program type of HCBS state plan option 1915(i), then the state plan option participation segment has a plan option type is equal to '2'.
RULE-6488	The format for STATE-PLAN-OPTION-TYPE on the ELG00011 segment was expected to be submitted as X(2).

Measure ID	Measure Name
ALL-2-002-2	% of MSIS IDs in Community First Choice (STATE-PLAN-OPTION-TYPE = '01') during the reporting period with any claim lines
ALL-2-003-3	% of active 1915(i) MSIS IDs (STATE-PLAN-OPTION-TYPE = '02') during the reporting period with any claim lines
ALL-2-004-4	% of active 1915(i) MSIS IDs (STATE-PLAN-OPTION-TYPE = '02') during the reporting period with 1915(i) claim lines (HCBS-SERVICE-CODE = '1')
ALL-2-005-5	% of active 1915(j) MSIS IDs (STATE-PLAN-OPTION-TYPE = '03') during the reporting period with any claim lines
ALL-2-006-6	% of active 1915(j) MSIS IDs (STATE-PLAN-OPTION-TYPE = '03') during the reporting period with 1915(j) claim lines (HCBS-SERVICE-CODE = '2')
MIS-1-060-60	% distinct MSIS IDs with only missing values in any active segment: STATE-PLAN-OPTION-TYPE (ELG00011)
ALL-2-008-8	OT- % of 1915(c) or 1915(i) eligibles (WAIVER-TYPE = '06' - '20' or ‘33’ or STATE-PLAN-OPTION-TYPE = '02') with HCBS-TAXONOMY claims

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	ELG.011.163	UPDATE	Coding requirement	1. Value must be in State Plan Option Type List (VVL)2. If associated Eligibility Group (ELG.005.087) value is in [ "72", "73", "74", "75" ], and Restricted Benefits Code (ELG.DE.097) is "1" or "7", then value must be "06"3. Value must be 2 characters4. Mandatory5. Value must equal '02' when Program Type (CIP.002.129) equals '13'6. Value must equal '02' when Program Type (COT.002.065) equals '13'	1. Value must be in State Plan Option Type List (VVL)2. If associated Eligibility Group (ELG.005.087) value is in [ "72", "73", "74", "75" ], and Restricted Benefits Code (ELG.DE.097) is "1" or "7", then value must be "06"3. Value must be 2 characters4. Mandatory5. Value must equal "02" when Program Type (CIP.002.129) equals "13"6. Value must equal "02" when Program Type (COT.002.065) equals "13"
09/21/2023	3.13.0	ELG.011.163	UPDATE	Segment key field identifier	Not Applicable	3
05/13/2022	3.0.0	ELG163	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT\| ELG163\|STATE-PLAN-OPTION-TYPE\|Beneficiaries reported with ELIGIBILITY-GROUP="72", "73", "74", "75" are expected to be covered by an alternative benefit plan and should be reported with RESTRICTED-BENEFITS-CODE=7 and STATE-PLAN-OPTION-TYPE="06”.\|	DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT\| ELG163\|STATE-PLAN-OPTION-TYPE\|Beneficiaries reported with ELIGIBILITY-GROUP="72", "73", "74", "75" are expected to be covered by an alternative benefit plan and should be reported with STATE-PLAN-OPTION-TYPE="06” and either RESTRICTED-BENEFITS-CODE=”1” or "7".\|