MCR-5-011-20

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Measure Name	Average # of long-term care days, exclude 0
File Type	CLT
Measure ID	MCR-5-011-20
Measure Type	Average
Content area	MCR

Validation Type	Longitudinal and Inferential

Measure Priority	Medium
Focus Area	Managed care
Category	Utilization

Claim Type	Medicaid,Enc
Adjustment Type	Original
Crossover Type	Non-Crossover

Minimum	2
Maximum	31
TA Minimun	2
TA Maximum	31
Longitudinal Threshold	0.15
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	NURSING-FACILITY-DAYS • MEDICAID-COV-INPATIENT-DAYS • LEAVE-DAYS • ICF-IID-DAYS
DD Data Element Number	CLT149 • CLT086 • CLT148 • CLT147

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	MCR-5-011-20	UPDATE	Annotation	Average number of long-term care days (exclude 0) for Medicaid Encounter: original, non-crossover, paid LT claims	N/A
11/20/2025	4.0.22	MCR-5-011-20	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total long-term care days is positiveOf the claims that meet the criteria from STEP 2:1. Create Total_LTC_Days as the sum of LEAVE-DAYS, ICF-IID-DAYS, NURSING-FACILITY-DAYS and MEDICAID-COV-INPATIENT-DAYS2. Keep claims with Total_LTC_Days > 0STEP 4: Sum total LTC daysSum Total_LTC_Days for all claims in STEP 3STEP 5: Calculate the average for measureDivide the sum from STEP 4 by the count of claims from STEP 3	N/A
04/24/2025	4.0.7	MCR-5-011-20	ADD	N/A		Created

MCR-5-011-20

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements