MCR-54-004-4

Data Quality Measure

Last updated

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Key Information

Measure Name	# of plans with at least 100 enrollments and some capitations that have capitation ratios outside of the expected range (0.7 - 1.3)
File Type	COT
Measure ID	MCR-54-004-4
Measure Type	Count
Content area	MCR

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	Managed care
Category	Expenditures

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 and some capitation that have a capitation ratio outside of (0.7, 1.3), excluding those with plan types: 02, 03, 17, 60, 70, 99 or missing
Specification	STEP 1: Exclude PCCM, PACE, Health Home, ACO, 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 and capitation Of the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria: 1. Enrollment >= 100 2. Total_Capitation > 0 STEP 3: Capitation ratio out of expected range Of the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where: 1. Capitation_Ratio < 0.7 OR Capitation_Ratio > 1.3

Annotation

Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some capitation that have a capitation ratio outside of (0.7, 1.3), excluding those with plan types: 02, 03, 17, 60, 70, 99 or missing

Specification

STEP 1: Exclude PCCM, PACE, Health Home, ACO, 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 and capitation

Of the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria:

1. Enrollment >= 100

2. Total_Capitation > 0

STEP 3: Capitation ratio out of expected range

Of the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where:

1. Capitation_Ratio < 0.7 OR Capitation_Ratio > 1.3