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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

MCR-54-008-8

Data Quality Measure
Last updated

Key Information

Measure Name # of plans with at least 100 enrollments and some encounters that have RX ratios outside of the expected range (0.02 - 5)
File Type Multiple Files
Measure ID MCR-54-008-8
Measure Type Count
Content area MCR

Validation

Validation Type Inferential

Measure Priority

Measure Priority Medium
Focus Area Managed care
Category Utilization

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 TYPE-OF-SERVICE
DD Data Element Number COT186

Annotation Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have an encounter RX ratio outside of (0.02, 5), with plan types equal to 01, 04, 18, or 80
Specification STEP 1: Include Comprehensive MCO, HIO, Pharmacy PAHP, and Integrated Care for Duals Plan Types

Of the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:

1. Plan_Type_El is equal to ("01","04", "18", or "80")



STEP 2: Enrollment and encounters

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_Encounters > 0



STEP 3: Encounters RX ratio out of expected range

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

1. Encounters_Rx_Ratio < 0.02 OR Encounters_Rx_Ratio > 5