Key Information

Measure Name	# of managed care plan enrollees
File Type	ELG
Measure ID	EL-10-003-2
Measure Type	Count
Content area	ELG MCR MULTI

Validation

Validation Type	Longitudinal

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	N/A
Maximum	N/A
TA Minimun
TA Maximum
Longitudinal Threshold	0.1
For TA (for including in compliance training)	TA- Longitudinal
For TA (Longitudinal)	Yes

Data Elements

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

Annotation

Count the total number of MSIS ID's that are enrolled in at least one managed care plan with a valid 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: Unique Valid Values Of the MSIS IDs which meet the criteria from STEP 2, restrict to those with a valid MANAGED-CARE-PLAN-TYPE: 1. MANAGED-CARE-PLAN-TYPE = "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "60", "70", "80" STEP 4: Count unique MSIS IDs Count the number of unique MSIS IDs from STEP 3