Key Information

Measure Name	# of plans with at least 100 enrollments or 100 capitations, 0 encounters
File Type	FTX
Measure ID	MCR-54-002-2
Measure Type	Count
Content area	MCR

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
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	STATE-PLAN-ID-NUM • MANAGED-CARE-PLAN-TYPE • TYPE-OF-SERVICE • PLAN-ID-NUMBER • MANAGED-CARE-PLAN-TYPE • MANAGED-CARE-PLAN-ID • PLAN-ID-NUMBER • PLAN-ID-NUMBER • PLAN-ID-NUMBER • OFFSET-TRANS-TYPE • PAYEE-MCR-PLAN-TYPE • PAYMENT-OR-RECOUPMENT-AMOUNT • PAYMENT-AMOUNT • PAYEE-ID-TYPE • MBESCBES-FORM-GROUP • PAYMENT-OR-RECOUPMENT-AMOUNT
DD Data Element Number	MCR019 • ELG193 • COT186 • CLT080 • MCR024 • ELG192 • CIP130 • CRX056 • COT066 • FTX184 • FTX036 • FTX157 • FTX072 • FTX034 • FTX048 • FTX025

Annotation

Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some capitations or at least 100 capitations and some enrollment that don't have encounters, excluding those with plan types: 02, 03, 17, 60, 70, 99, or missing

Specification

STEP 1: Exclude PCCM, PACE, Health Home, ACO, Missing Plan Types Of the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where: 1. Plan_Type_El is not equal to ("02","03", "17", "60", "70", or "99") or is missing STEP 2: Enrollment or capitation without encounters Of the Plan_Ids that meet the criteria in STEP 1, count the non-missing Plan_Ids that also satisfy the following criteria: 1a. Enrollment >= 100 2a. Total_Capitation > 0 OR 1b. Enrollment > 0 2b. Total_Capitation >= 100 AND 3. Total_Encounters = 0