MCR.005.067

OPERATING-AUTHORITY

Data Element

DE Number

MCR067

System DE Number

MCR.005.067

File Name

MCR - MANAGED CARE PLAN INFORMATION

File Segment Number

MCR00005

File Segment Name

MANAGED-CARE-OPERATING-AUTHORITY

Last updated

09/12/2024

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The type of operating authority through which the managed care entity receives its contract authority. The Managed Care Plan Type assigned to the manage care plan in the Managed Care Main segment should be consistent with the Operating Authority value reported. 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/47566
Size	X(2)
FLF Start Position	34
FLF Stop Position	35
Segment Key Field Identifier	3
Coding Requirements	1. Value must be in Operating Authority 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
OPERATING-AUTHORITY	01	1115 demonstration waiver program - demonstration projects under which most provisions of Section 1902 of the Social Security Act are waived and/or expenditures that would not otherwise be eligible for FFP are authorized. States use these to expand eligibility, restructure Medicaid coverage and secure programmatic flexibility.	01/01/0001	12/31/9999
OPERATING-AUTHORITY	02	1915(b) waiver program - waivers of most provisions of Section 1902 of the Social Security Act in order to limit beneficiaries' freedom of choice of provider; selectively contract with providers; or provide additional services to beneficiaries (State may include BBA special populations)	01/01/0001	12/31/9999
OPERATING-AUTHORITY	03	1932(a) state plan option to use managed care for MCO and PCCM programs - mandatory managed care programs implemented through the state plan (State must exclude or permit voluntary enrollment of specific populations)	01/01/0001	12/31/9999
OPERATING-AUTHORITY	04	1915(a) voluntary managed care program - an MCO managed care program in which enrollment is voluntary and therefore does not require a waiver.	01/01/0001	12/31/9999
OPERATING-AUTHORITY	05	Concurrent 1915(b)/1915(c) waivers- programs, or portions thereof, operating under both 1915(b) managed care and 1915(c) home and community-based services waivers.	01/01/0001	12/31/9999
OPERATING-AUTHORITY	06	Concurrent 1915(a)/1915(c) waivers- programs, or portions thereof, operating under both 1915(a) voluntary managed care and 1915(c) home and community-based services waiver	01/01/0001	12/31/9999
OPERATING-AUTHORITY	07	Concurrent 1932(a)/1915(c) waivers - programs, or portions thereof, operating under both 1932(a) managed care and 1915(c) home and community-based services waiver.	01/01/0001	12/31/9999
OPERATING-AUTHORITY	08	PACE - program that provides pre-paid, capitated comprehensive, health care services to the frail elderly.	01/01/0001	12/31/9999
OPERATING-AUTHORITY	09	1905(t) voluntary PCCM program - A PCCM managed care program in which enrollment is voluntary and therefore does not require a waiver.	01/01/0001	12/31/9999
OPERATING-AUTHORITY	10	1937benchmark benefit program-programs to provide benefits that differ from Medicaid state plan benefits using managed care and implemented through the state plan.	01/01/0001	12/31/9999
OPERATING-AUTHORITY	11	1902(a)(70) non-emergency medical transportation program -non-emergency medical transportation brokerage programs implemented through the state plan which can vary scope of services, operate on a less-than-statewide basis, and limit freedom of choice	01/01/0001	12/31/9999
OPERATING-AUTHORITY	12	Concurrent 1915(b)/1915(i) HCBS state plan services - the optional 1915(i) state plan Home and Community-Based Services (HCBS) benefit operated in conjunction with a 1915(b) managed care waiver program.	01/01/0001	12/31/9999
OPERATING-AUTHORITY	13	Concurrent 1915(a)/ 1915(i) HCBS state plan services - the optional 1915(i) state plan Home and Community-Based Services (HCBS) benefit operated in conjunction with a 1915(a) voluntary managed care program.	01/01/0001	12/31/9999
OPERATING-AUTHORITY	14	Concurrent 1932(a)/ 1915(i) HCBS state plan services - the optional 1915(i) state plan Home and Community-Based Services (HCBS) benefit operated in conjunction with a 1932(a) managed care state plan option.	01/01/0001	12/31/9999
OPERATING-AUTHORITY	15	1945 Health Homes.	01/01/0001	12/31/9999
OPERATING-AUTHORITY	16	Concurrent 1915(a)/1915(j) - programs, or portions thereof, operating under both 1915(a) and 1915(j) authorities	01/01/0001	12/31/9999
OPERATING-AUTHORITY	17	Concurrent 1932(a)/1915(j) - programs, or portions thereof, operating under both 1932(a) and 1915(j) authorities	01/01/0001	12/31/9999
OPERATING-AUTHORITY	18	Concurrent 1915(b)/1915(j) - programs, or portions thereof, operating under both 1915(b) and 1915(j) authorities	01/01/0001	12/31/9999
OPERATING-AUTHORITY	19	Concurrent 1115/1915(j) - programs, or portions thereof, operating under both 1115 and 1915(j) authorities	01/01/0001	12/31/9999
OPERATING-AUTHORITY	20	Concurrent 1915(a)/1915(k) - programs, or portions thereof, operating under both 1915(a) and 1915(k) authorities	01/01/0001	12/31/9999
OPERATING-AUTHORITY	21	Concurrent 1932(a)/1915(k) - programs, or portions thereof, operating under both 1932(a) and 1915(k) authorities	01/01/0001	12/31/9999
OPERATING-AUTHORITY	22	Concurrent 1915(b)/1915(k) - programs, or portions thereof, operating under both 1915(b) and 1915(k) authorities	01/01/0001	12/31/9999
OPERATING-AUTHORITY	23	Concurrent 1115/1915(k) - programs, or portions thereof, operating under both 1115 and 1915(k) authorities	01/01/0001	12/31/9999

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RULE ID	RULE Definition
RULE-2653	If the operating authority is populated on a managed care operating authority file, then the operating authority reported must be found in the list of valid values.
RULE-7088	If a segment is a managed care operating authority segment, then the operating authority value reported must be compatible with the specified T-MSIS picture format: X(2).

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Measure ID	Measure Name
MCR-29-002-2	Operating Authority comparison with MMCDCS
MCR-S-003-26	# of Operating Authorities that are found in T-MSIS or MMCDCS but not both
MIS-10-015-15	% distinct STATE-PLAN-ID-NUMs with only missing values in any active segment: OPERATING-AUTHORITY (MCR00005)

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DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
No data available in table

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	MCR.005.067	UPDATE	Coding requirement	1. Value must be in Operating Authority List (VVL)2. Value must be 2 characters or less3. Mandatory	1. Value must be in Operating Authority List (VVL)2. Value must be 2 characters3. Mandatory
09/21/2023	3.13.0	MCR.005.067	UPDATE	Segment key field identifier	Not Applicable	3
08/13/2021	3.0.0	OPERATING-AUTHORITY (MCR067)	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|OPERATING-AUTHORITY\|00010101\|99991231\|16\|Concurrent 1915(a)/1915(j) - programs, or portions thereof, operating under both 1915(a) and 1915(j) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|17\|Concurrent 1932(a)/1915(j) - programs, or portions thereof, operating under both 1932(a) and 1915(j) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|18\|Concurrent 1915(b)/1915(j) - programs, or portions thereof, operating under both 1915(b) and 1915(j) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|19\|Concurrent 1115/1915(j) - programs, or portions thereof, operating under both 1115 and 1915(j) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|20\|Concurrent 1915(a)/1915(k) - programs, or portions thereof, operating under both 1915(a) and 1915(k) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|21\|Concurrent 1932(a)/1915(k) - programs, or portions thereof, operating under both 1932(a) and 1915(k) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|22\|Concurrent 1915(b)/1915(k) - programs, or portions thereof, operating under both 1915(b) and 1915(k) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|23\|Concurrent 1115/1915(k) - programs, or portions thereof, operating under both 1115 and 1915(k) authorities\|