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Measure Name | Average # of managed care plans per enrollee |
---|---|
File Type | ELG |
Measure ID | EL-10-002-4 |
Measure Type | Average |
Content area | ELG MCR MULTI |
Validation Type | Longitudinal and Inferential |
---|
Measure Priority | Medium |
---|---|
Focus Area | Managed care |
Category | Program participation |
Claim Type | N/A |
---|---|
Adjustment Type | N/A |
Crossover Type | N/A |
Minimum | 1 |
---|---|
Maximum | 3 |
TA Minimun | 1 |
TA Maximum | 3 |
Longitudinal Threshold | 0.15 |
For TA
(for including in compliance training) |
TA- Inferential and Longitudinal |
For TA
(Longitudinal) |
Yes |
DD Data Element | MSIS-IDENTIFICATION-NUM • MANAGED-CARE-PLAN-ID • MANAGED-CARE-PLAN-TYPE |
---|---|
DD Data Element Number | ELG191 • ELG192 • ELG193 |
Annotation | For each unique MSIS id, count the unique number of non-missing plan ids that have a valid or unknown plan type. Calculate the average count by dividing the number of plan ids from above by the number of unique MSIS ids that have a non-missing plan id with a valid or unknown plan type. |
---|---|
Specification |
STEP 1: Enrolled on the last day of DQ report month Define the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria: 1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing 3. MSIS-IDENTIFICATION-NUM is not missing STEP 2: Managed care enrollment on the last day of DQ report month Using the MSIS IDs that meet the criteria from STEP 1, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria: 1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month 2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missing OR 1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing 2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missing STEP 3: Non-missing Plan ID and valid plan type Of the MSIS IDs which meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria: 1. MANAGED-CARE-PLAN-ID is not missing 2. MANAGED-CARE-PLAN-TYPE is not equal to "00" STEP 4: Count plan ID's For each MSIS ID that meets the criteria from STEP 3, create Count_Plans and set it equal to the number of unique MANAGED-CARE-PLAN-ID values associated with that MSIS-ID. STEP 5: Calculate average number of managed care plans Divide the sum of Count_Plans from STEP 4 by the count of unique MSIS IDs from STEP 3 |