ELG.014.193

MANAGED-CARE-PLAN-TYPE

Data Element

DE Number

ELG193

System DE Number

ELG.014.193

File Name

ELG - ELIGIBLE

File Segment Number

ELG00014

File Segment Name

MANAGED-CARE-PARTICIPATION

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A model of health care delivery organized to provide a defined set of services. See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Non-Emergency Medical Transportation (NEMT) Prepaid Ambulatory Health Plans (PAHPs) in the T-MSIS Managed Care File" https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47540 See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Managed Care Plan Type in the T-MSIS Managed Care File" https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47564
Size	X(2)
FLF Start Position	54
FLF Stop Position	55
Segment Key Field Identifier	4
Coding Requirements	1. Value must be in Managed Care Plan Type List (VVL) 2. Value must be 2 characters 3. Mandatory 4. Value must not be populated when Managed Care Plan ID (ELG.014.192) is not populated 5. Value must equal the Managed Care Plan Type (MCR.002.024) associated with the State Plan Identification Number (MCR.002.018)

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

RULE ID	RULE Definition

Measure ID	Measure Name
MCR-65-008-8	% of LTSS (MANAGED-CARE-PLAN-TYPE = 07, 19) enrollees with no capitation payments for LTSS
MCR-55-003-3	PACE capitation ratio
MCR-9-006_1-18	% of PCCM (TYPE-OF-SERVICE) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan
MIS-1-069-69	% distinct MSIS IDs with only missing values in any active segment: MANAGED-CARE-PLAN-TYPE (ELG00014)
RULE-2382	% of record segments that do not have a managed care record
MCR-65-001-1	% of Comprehensive MCO (MANAGED-CARE-PLAN-TYPE = 01, 04) enrollees with no capitation payments for comprehensive MCO
MCR-65-002-2	% of PACE plan (MANAGED-CARE-PLAN-TYPE = 17) enrollees with no capitation payments for PACE
MCR-65-003-3	% of Transportation PAHP (MANAGED-CARE-PLAN-TYPE = 15) enrollees with no capitation payments for Transportation PAHPs
MCR-65-004-4	% of Dental PAHP (MANAGED-CARE-PLAN-TYPE = 14) enrollees with no capitation payments for Dental PAHPs
MCR-65-005-5	% of Pharmacy PAHP (MANAGED-CARE-PLAN-TYPE = 18) enrollees with no capitation payments for Pharmacy PAHPs
MCR-65-006-6	% of Mental Health PIHP (MANAGED-CARE-PLAN-TYPE = 08, 10, 12) enrollees with no capitation payments for Mental Health PIHPs
MCR-65-007-7	% of Mental Health PAHP (MANAGED-CARE-PLAN-TYPE = 09, 11, 13) enrollees with no capitation payments for Mental Health PAHPs
MCR-55-002-2	Enhanced PCCM capitation ratio
MCR-65-009-9	% of Disease Management (MANAGED-CARE-PLAN-TYPE = 02, 03, 16) enrollees with no capitation payments for Disease Management
MCR-65-010-10	% of ACO (MANAGED-CARE-PLAN-TYPE = 60) enrollees with no capitation payments for ACOs
MCR-65-011-11	% of Health/Medical Home (MANAGED-CARE-PLAN-TYPE = 70) enrollees with no capitation payments for Health/Medical Home
MCR-65-012-12	% of Integrated Care for Dual Eligibles (MANAGED-CARE-PLAN-TYPE = 80) enrollees with no capitation payments for Integrated Care for Dual Eligibles
EL-8-001-1	Enrollment, capitation payments, and encounters by Plan Type
MCR-13-018-20	% of PHP (TYPE-OF-SERVICE ) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation PHP plan
MCR-9-018-20	% of PHP (TYPE-OF-SERVICE ) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation PHP plan
MCR-13-019-21	% of Comprehensive MCO (TYPE-OF-SERVICE) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation Comprehensive MCO plan
MCR-9-019-21	% of Comprehensive MCO (TYPE-OF-SERVICE) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation Comprehensive MCO plan
RULE-7407	% of segments with a valid plan type that are missing plan ID
RULE-7408	% of segments with a non-missing plan ID that are missing plan type
MCR-53-001-1	Total # of managed care enrollments
EL-10-002-4	Average # of managed care plans per enrollee
EL-10-003-2	# of managed care plan enrollees
EL-10-004-5	% of MSIS IDs with restricted benefit (RESTRICTED-BENEFITS-CODE = 02, 03, or 06) enrolled in comprehensive managed care (MANAGED-CARE-PLAN-TYPE = 01)
EL-10-005-6	% of MSIS IDs in CHIP enrolled in comprehensive managed care (MANAGED-CARE-PLAN-TYPE = 01)
EL-10-006-3	% of MSIS IDs with more than one valid Managed Care Plan Type
EL-10-007-7	% MSIS IDs with a valid plan type that are missing plan ID
EL-10-008-8	% of MSIS IDs with a non-missing plan ID that are missing plan type
EL-3-004-2	% of MSIS IDs with age 65+ that are enrolled in comprehensive managed care (MANAGED-CARE-PLAN-TYPE = 01)
EL-8-002-2	Enrollment, capitation payments, capitation ratios, encounters (by claim file type) and encounter ratios (by claim file type) by plan ID with plan ID linking to MC file
EL-9-001-1	Enrollment by plan ID
MCR-13-006_1-18	% of PCCM (TYPE-OF-SERVICE) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan
EL-10-001-1	Index of dissimilarity - plan type
MCR-53-002-2	Total # of managed care capitations
MCR-53-003-3	Total # of managed care encounters
MCR-54-001-1	# of plans with at least 100 enrollments, 0 capitations, 0 encounters
MCR-54-002-2	# of plans with at least 100 enrollments or 100 capitations, 0 encounters
MCR-54-003-3	# of plans with at least 100 enrollments or 100 encounters, 0 capitations
MCR-54-004-4	# of plans with at least 100 enrollments and some capitations that have capitation ratios outside of the expected range (0.7 - 1.3)
MCR-54-005-5	# of plans with at least 100 capitations or 100 encounters, 0 enrollments
MCR-54-009-9	# of plans with at least 100 enrollments, capitations, or encounters, that do not have a managed care record
MCR-54-010-10	# of plans where MC plan type does not match EL plan type
MCR-55-001-1	Traditional PCCM capitation ratio

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
MCR024	MCR.002.024	MANAGED-CARE-PLAN-TYPE	MCR00002	MANAGED-CARE-MAIN

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/21/2020	2.4.0	MANAGED-CARE-PLAN-TYPE (ELG193, MCR024)	UPDATE	Data Dictionary - Valid Values	\|Data Element Name\|Valid Value\|Description\|Effective Date\|End Date\| \|MANAGED-CARE-PLAN-TYPE\|70\|Health/Medical Home\|01/01/0001\|12/31/9999\|	\|Data Element Name\|Valid Value\|Description\|Effective Date\|End Date\| \|MANAGED-CARE-PLAN-TYPE\|70\|Health/Medical Home\|01/01/0001\|09/30/2020\|
09/11/2020	2.4.0	MANAGED-CARE-PLAN-TYPE	ADD	Data Dictionary - Valid Values	N/A	\|Code\|Description\| \|19\|Individual is enrolled in Long-Term Services & Supports (LTSS) and Mental Health (MH) PIHP\| \|20\|Other\|
09/11/2020	2.4.0	MANAGED-CARE-PLAN-TYPE	ADD	Data Dictionary - Valid Values	N/A	\|Code\|Description\|Effective Date\|End Date\| \|19\|Individual is enrolled in Long-Term Services & Supports (LTSS) and Mental Health (MH) PIHP\|00010101\|99991231\|