CLT.003.209

MEDICAID-FFS-EQUIVALENT-AMT

Data Element

DE Number

CLT209

System DE Number

CLT.003.209

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

CLT00003

File Segment Name

CLAIM-LINE-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The amount that would have been paid had the services been provided on a Fee for Service basis.
Size	S9(11)V99
FLF Start Position	272
FLF Stop Position	284
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be between -99999999999.99 and 99999999999.99 2. Value must be expressed as a number with 2-digit precision (e.g. 100.50 ) 3. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided 4. Conditional

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-1240	If a claim is a non-denied claim from an LT file, then the medicaid FFS equivalent amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.

Measure ID	Measure Name
MCR-6-017-15	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 59 (Skilled nursing facility services for individuals under age 21)
MCR-6-026-18	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 133 (Supplemental payment - nursing)
MCR-6-025-25	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 59 (Skilled nursing facility services for individuals under age 21)
MCR-6-024-24	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 50 (Inpatient substance abuse treatment services and residential substance abuse treatment services.)
MCR-6-023-23	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 48 (Inpatient psychiatric services for individuals under age 21)
MCR-6-022-22	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 47 (Nursing facility services, other than in institutions for mental diseases)
MCR-6-021-21	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 46 (Intermediate care facility (ICF/IIDICF/IID) services)
MCR-6-020-20	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 45 (Nursing facility services for individuals age 65 or older in institutions for mental diseases)
MCR-6-019-19	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 44 (Inpatient hospital services for individuals age 65 or older in institutions for mental diseases)
MCR-6-018-17	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 9 (Nursing facility services; age 21 or older)
MIS-5-010-10	% missing: MEDICAID-FFS-EQUIVALENT-AMT (CLT00003)
MCR-6-016-14	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 50 (Inpatient substance abuse treatment services and residential substance abuse treatment services.)
MCR-6-015-13	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 48 (Inpatient psychiatric services for individuals under age 21)
MCR-6-014-12	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 47 (Nursing facility services, other than in institutions for mental diseases)
MCR-6-013-11	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 46 (Intermediate care facility (ICF/IIDICF/IID) services)
MCR-6-012-10	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 45 (Nursing facility services for individuals age 65 or older in institutions for mental diseases)
MCR-6-011-9	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 44 (Inpatient hospital services for individuals age 65 or older in institutions for mental diseases)
MCR-6-010-16	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 9 (Nursing facility services; age 21 or older)
MIS-82-008-8	% missing: MEDICAID-FFS-EQUIVALENT-AMT (CLT00003)
MIS-24-009-9	% missing: MEDICAID-FFS-EQUIVALENT-AMT (CLT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP255	CIP.003.255	MEDICAID-FFS-EQUIVALENT-AMT	CIP00003	CLAIM-LINE-RECORD-IP
COT179	COT.003.179	MEDICAID-FFS-EQUIVALENT-AMT	COT00003	CLAIM-LINE-RECORD-OT
CRX126	CRX.003.126	MEDICAID-FFS-EQUIVALENT-AMT	CRX00003	CLAIM-LINE-RECORD-RX