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

09/21/2023

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

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Valid Value Code Set	Valid Value Code	Valid Value Name	Effective Start Date	Effective End Date
MANAGED-CARE-PLAN-TYPE	01	Comprehensive MCO	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	02	Traditional PCCM Provider	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	03	Enhanced PCCM Provider	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	04	HIO	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	05	Medical-only PIHP (risk or non-risk/non-comprehensive/with inpatient hospital or institutional services)	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	06	Medical-only PAHP (risk or non-risk/non-comprehensive/no inpatient hospital or institutional services)	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	07	Long Term Care (LTC) PIHP	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	08	Mental Health (MH) PIHP	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	09	Mental Health (MH) PAHP	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	10	Substance Use Disorders (SUD) PIHP	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	11	Substance Use Disorders (SUD) PAHP	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	12	Mental Health (MH) and Substance Use Disorders (SUD) PIHP	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	13	Mental Health (MH) and Substance Use Disorders (SUD) PAHP	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	14	Dental PAHP	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	15	Transportation PAHP	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	16	Disease Management PAHP	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	17	PACE	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	18	Pharmacy PAHP	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	19	Individual is enrolled in Long-Term Services & Supports (LTSS) and Mental Health (MH) PIHP	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	20	Other	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	60	Accountable Care Organization	01/01/0001	12/31/9999
MANAGED-CARE-PLAN-TYPE	70	Health/Medical Home	01/01/0001	09/30/2020
MANAGED-CARE-PLAN-TYPE	80	Integrated Care For Dual Eligibles	01/01/0001	12/31/9999

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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).

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

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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
09/21/2023	3.13.0	MCR.002.024	UPDATE	Segment key field identifier	Not Applicable	3
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\|
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\|