MCR-55-004-4

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TMSIS Dataguide

Medicaid.gov

Version:

MCR-55-004-4 DEPRECATED

Data Quality Measure

Last updated

Key Information

Measure Name	Health home capitation ratio
File Type	Multiple Files
Measure ID	MCR-55-004-4
Measure Type	Ratio
Content area	MCR

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	N/A
Focus Area	N/A
Category	N/A

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	N/A
For TA (for including in compliance training)	No
For TA (Longitudinal)	No

Data Elements

DD Data Element	OFFSET-TRANS-TYPE • PAYMENT-OR-RECOUPMENT-AMOUNT • PAYEE-MCR-PLAN-TYPE • PAYMENT-AMOUNT • PAYEE-ID-TYPE • MBESCBES-FORM-GROUP • PAYMENT-OR-RECOUPMENT-AMOUNT
DD Data Element Number	FTX184 • FTX157 • FTX036 • FTX072 • FTX034 • FTX048 • FTX025

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	MCR-55-004-4	UPDATE	Annotation	Calculate overall capitation ratio for plan ids in the EL-8-002-2 table with plan type equal to 70	N/A
11/20/2025	4.0.22	MCR-55-004-4	UPDATE	Specification	STEP 1: Health Home Plan TypeOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El = "70"STEP 2: Capitation RatioOf the Plan_Ids that meet the criteria in STEP 1, calculate the HHome_Capitation_Ratio as sum of Capitation_Total / sum of Enrollment	N/A
04/24/2025	4.0.7	MCR-55-004-4	ADD	N/A		Created