MCR.002.024

MANAGED-CARE-PLAN-TYPE

Data Element

DE Number

MCR024

System DE Number

MCR.002.024

File Name

MCR - MANAGED CARE PLAN INFORMATION

File Segment Number

MCR00002

File Segment Name

MANAGED-CARE-MAIN

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The type of managed care plan that corresponds to the State Plan Identification Number. The value reported in this data element should match the Managed Care Plan Type value reported on the Eligible file for the corresponding managed care plan number. Assign plan type value "15" for plans that primarily cover non-emergency medical transportation (NEMT). 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	106
FLF Stop Position	107
Segment Key Field Identifier	3
Coding Requirements	1. Value must be in Managed Care Plan Type List (VVL) 2. Value must be 2 characters 3. Mandatory

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

RULE ID	RULE Definition
RULE-2384	If the managed care participation plan type is populated on a managed care participation segment and the managed care main plan type is populated on the managed care main file segment and the managed care participation managed care plan enrollment end date is greater than the states tmsis cutover date then managed care participation managed care plan type equals the managed care main managed care plan type and the effective and end dates on the managed care participation segment must fall within the effective and end dates of one or more continuous managed care main segments.
RULE-2568	If managed care plan type is populated on a managed care main segment from an MCR file, then the managed care plan type value reported must be in the list of valid values for managed care plan type.
RULE-7014	If a segment is a managed care main segment from a MCR file, the managed care plan type value reported must be compatible with the specified T-MSIS picture format: X(2).

Measure ID	Measure Name
MCR-54-009-9	# of plans with at least 100 enrollments, capitations, or encounters, that do not have a managed care record
MCR-S-002-25	# of Plan Types that are found in T-MSIS or MMCDCS but not both
MCR-29-001-1	Plan Type comparison with MMCDCS
EL-8-001-1	Enrollment, capitation payments, and encounters by Plan Type
RULE-2382	% of record segments that do not have a managed care record
MIS-10-002-2	% distinct STATE-PLAN-ID-NUMs with only missing values in any active segment: MANAGED-CARE-PLAN-TYPE (MCR00002)
MCR-55-003-3	PACE capitation ratio
MCR-55-002-2	Enhanced PCCM capitation ratio
MCR-55-001-1	Traditional PCCM capitation ratio
MCR-54-010-10	# of plans where MC plan type does not match EL plan type
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
MCR-54-005-5	# of plans with at least 100 capitations or 100 encounters, 0 enrollments
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-54-003-3	# of plans with at least 100 enrollments or 100 encounters, 0 capitations
MCR-54-002-2	# of plans with at least 100 enrollments or 100 capitations, 0 encounters
MCR-54-001-1	# of plans with at least 100 enrollments, 0 capitations, 0 encounters
MCR-53-003-3	Total # of managed care encounters
MCR-53-002-2	Total # of managed care capitations
MCR-53-001-1	Total # of managed care enrollments
MCR-28-001-1	% of plan IDs with capitation payment ratios <0.9 or >1.1 (non-PCCM)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
ELG193	ELG.014.193	MANAGED-CARE-PLAN-TYPE	ELG00014	MANAGED-CARE-PARTICIPATION

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\|