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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

MCR-55-003-3

Data Quality Measure
Last updated

Key Information

Measure Name PACE capitation ratio
File Type COT
Measure ID MCR-55-003-3
Measure Type Ratio
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 0.7
Maximum 1.3
TA Minimun 0.7
TA Maximum 1.3
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 • ADJUSTMENT-IND • TYPE-OF-CLAIM • TYPE-OF-SERVICE • ADJUSTMENT-IND • TYPE-OF-CLAIM • TYPE-OF-CLAIM • PLAN-ID-NUMBER • MANAGED-CARE-PLAN-TYPE • MANAGED-CARE-PLAN-ID • ADJUSTMENT-IND • PLAN-ID-NUMBER • PLAN-ID-NUMBER • ADJUSTMENT-IND • PLAN-ID-NUMBER
DD Data Element Number MCR019 • ELG193 • CRX025 • COT037 • COT186 • CIP026 • CIP100 • CLT052 • CLT080 • MCR024 • ELG192 • COT025 • CIP130 • CRX056 • CLT025 • COT066

Annotation Calculate overall capitation ratio for plan ids in the EL-8-002-2 table with plan type equal to 17
Specification STEP 1: PACE Plan Type

Of the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:

1. Plan_Type_El = "17"



STEP 2: Capitation Ratio

Of the Plan_Ids that meet the criteria in STEP 1, calculate the PACE_Capitation_Ratio as sum of Capitation_Total / sum of Enrollment