EL-10-002-4

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Measure Name	Average # of managed care plans per enrollee
File Type	ELG
Measure ID	EL-10-002-4
Measure Type	Average
Content area	ELG MCR MULTI

Validation Type	Longitudinal and Inferential

Measure Priority	Medium
Focus Area	Managed care
Category	Program participation

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

Minimum	1
Maximum	3
TA Minimun	1
TA Maximum	3
Longitudinal Threshold	0.15
For TA (for including in compliance training)	TA- Inferential and Longitudinal
For TA (Longitudinal)	Yes

DD Data Element	MANAGED-CARE-PLAN-TYPE • MANAGED-CARE-PLAN-ID • MSIS-IDENTIFICATION-NUM
DD Data Element Number	ELG193 • ELG192 • ELG191

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	EL-10-002-4	UPDATE	Annotation	For each unique MSIS id, count the unique number of non-missing plan ids that have a valid or unknown plan type. Calculate the average count by dividing the number of plan ids from above by the number of unique MSIS ids that have a non-missing plan id with a valid or unknown plan type.	N/A
11/20/2025	4.0.22	EL-10-002-4	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Non-missing Plan ID and valid plan typeOf the MSIS IDs which meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. MANAGED-CARE-PLAN-ID is not missing2. MANAGED-CARE-PLAN-TYPE is not equal to "00"STEP 4: Count plan ID's For each MSIS ID that meets the criteria from STEP 3, create Count_Plans and set it equal to the number of unique MANAGED-CARE-PLAN-ID values associated with that MSIS-ID. STEP 5: Calculate average number of managed care plans Divide the sum of Count_Plans from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-10-002-4	ADD	N/A		Created

EL-10-002-4

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements