MCR-65-008-8

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TMSIS Dataguide

Medicaid.gov

Version:

MCR-65-008-8

Data Quality Measure

Last updated

Key Information

Measure Name	% of LTSS (MANAGED-CARE-PLAN-TYPE = 07, 19) enrollees with no capitation payments for LTSS
File Type	Multiple Files
Measure ID	MCR-65-008-8
Measure Type	Non-Claims Percentage
Content area	ELG MCR MULTI
Grace Period Expiration	01/30/2026

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	Managed care
Category	Program participation

Claim Information

Claim Type	N/A
Adjustment Type	N/A
Crossover Type	N/A

Thresholds

Minimum	0
Maximum	0.1
TA Minimun	0
TA Maximum	0.1
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	MANAGED-CARE-PLAN-TYPE • MSIS-IDENTIFICATION-NUM • MSIS-IDENTIFICATION-NUM • MSIS-IDENTIFICATION-NUM • MSIS-IDENTIFICATION-NUM • PAYEE-ID • PAYEE-ID • MANAGED-CARE-PLAN-ID • PAYEE-ID
DD Data Element Number	ELG193 • FTX042 • ELG191 • FTX173 • FTX086 • FTX078 • FTX033 • ELG192 • FTX163

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	MCR-65-008-8	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in LTSS that do not have Medicaid Capitation Payment Financial Transaction records	N/A
11/20/2025	4.0.22	MCR-65-008-8	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in LTSSOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("07" or "19")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without LTSSSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
10/07/2025	4.0.19	MCR-65-008-8	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-008-8	ADD	N/A		Created