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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

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 Calculate overall capitation ratio for plan ids in the EL-8-002-2 table with plan type equal to 70
Specification STEP 1: Health Home Plan Type

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

1. Plan_Type_El = "70"



STEP 2: Capitation Ratio

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