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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

EL-10-002-4

Data Quality Measure
Last updated

Key Information

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

Validation Type Longitudinal and Inferential

Measure Priority

Measure Priority Medium
Focus Area Managed care
Category Program participation

Claim Information

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

Thresholds

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

Data Elements

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

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.
Specification STEP 1: Enrolled on the last day of DQ report month

Define 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 missing

3. MSIS-IDENTIFICATION-NUM is not missing



STEP 2: Managed care enrollment on the last day of DQ report month

Using 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 month

2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missing

OR

1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing

2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missing



STEP 3: Non-missing Plan ID and valid plan type

Of 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 missing

2. 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