Key Information

Measure Name	# of plans with at least 100 enrollments, 0 capitations, 0 encounters
File Type	ELG
Measure ID	MCR-54-001-1
Measure Type	Count
Content area	MCR

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	Managed care
Category	Program participation

Claim Information

Claim Type	N/A
Adjustment Type	N/A
Crossover Type	N/A

Thresholds

Minimum	0
Maximum	0
TA Minimun	0
TA Maximum	0
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	PLAN-ID-NUMBER • PLAN-ID-NUMBER • PLAN-ID-NUMBER • PLAN-ID-NUMBER • MANAGED-CARE-PLAN-TYPE • STATE-PLAN-ID-NUM • MANAGED-CARE-PLAN-TYPE • MANAGED-CARE-PLAN-ID • TYPE-OF-SERVICE • ADJUSTMENT-IND • ADJUSTMENT-IND • ADJUSTMENT-IND • ADJUSTMENT-IND • TYPE-OF-CLAIM • TYPE-OF-CLAIM • TYPE-OF-CLAIM
DD Data Element Number	CIP130 • CLT080 • COT066 • CRX056 • MCR024 • MCR019 • ELG193 • ELG192 • COT186 • CIP026 • CLT025 • COT025 • CRX025 • CIP100 • CLT052 • COT037

Annotation

Count plan ids in the EL-8-002-2 table with at least 100 enrollments, but no capitation or encounters, excluding those with plan types: 02, 03, 17, 60, 70, 99, or missing

Specification

STEP 1: Exclude PCCM, PACE, ACO, Health Home, Missing Plan Types Of the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where: 1. Plan_Type_El is not equal to ("02","03", "17", "60", "70", or "99") or is missing STEP 2: Enrollment without capitation and encounters Of the Plan_Ids that meet the criteria in STEP 1, count the non-missing Plan_Ids that also satisfy the following criteria: 1. Enrollment >= 100 2. Total_Capitation = 0 3. Total_Encounters = 0