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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

MCR-54-004-4

Data Quality Measure
Last updated

Key Information

Measure Name # of plans with at least 100 enrollments and some capitations that have capitation ratios outside of the expected range (0.7 - 1.3)
File Type FTX
Measure ID MCR-54-004-4
Measure Type Count
Content area MCR

Validation

Validation Type Inferential

Measure Priority

Measure Priority High
Focus Area Managed care
Category Expenditures

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 capitation that have a capitation ratio outside of (0.7, 1.3), 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 and capitation

Of the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria:

1. Enrollment >= 100

2. Total_Capitation > 0



STEP 3: Capitation ratio out of expected range

Of the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where:

1. Capitation_Ratio < 0.7 OR Capitation_Ratio > 1.3