MCR-5-011-20

Data Quality Measure

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Key Information

Measure Name	Average # of long-term care days, exclude 0
File Type	CLT
Measure ID	MCR-5-011-20
Measure Type	Average
Content area	MCR

Validation

Validation Type	Longitudinal and Inferential

Measure Priority

Measure Priority	Medium
Focus Area	Managed care
Category	Utilization

Claim Information

Claim Type	Medicaid,Enc
Adjustment Type	Original
Crossover Type	Non-Crossover

Thresholds

Minimum	2
Maximum	31
TA Minimun	2
TA Maximum	31
Longitudinal Threshold	0.15
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	LEAVE-DAYS • NURSING-FACILITY-DAYS • ICF-IID-DAYS • MEDICAID-COV-INPATIENT-DAYS
DD Data Element Number	CLT148 • CLT149 • CLT147 • CLT086

Annotation	Average number of long-term care days (exclude 0) for Medicaid Encounter: original, non-crossover, paid LT claims
Specification	STEP 1: Active non-duplicate paid LT claims during report month Define the LT claims universe at the header level that satisfy the following criteria: 1. Reporting Period from the filename = DQ report month 2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing 3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing 4. TYPE-OF-CLAIM is not equal to "Z" or is missing 5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing 6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid Claims Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria: 1. TYPE-OF-CLAIM = "3" 2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missing STEP 3: Total long-term care days is positive Of the claims that meet the criteria from STEP 2: 1. Create Total_LTC_Days as the sum of LEAVE-DAYS, ICF-IID-DAYS, NURSING-FACILITY-DAYS and MEDICAID-COV-INPATIENT-DAYS 2. Keep claims with Total_LTC_Days > 0 STEP 4: Sum total LTC days Sum Total_LTC_Days for all claims in STEP 3 STEP 5: Calculate the average for measure Divide the sum from STEP 4 by the count of claims from STEP 3

Annotation

Average number of long-term care days (exclude 0) for Medicaid Encounter: original, non-crossover, paid LT claims

Specification

STEP 1: Active non-duplicate paid LT claims during report month

Define the LT claims universe at the header level that satisfy the following criteria:

1. Reporting Period from the filename = DQ report month

2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing

3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing

4. TYPE-OF-CLAIM is not equal to "Z" or is missing

5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing

6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.

STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid Claims

Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria:

1. TYPE-OF-CLAIM = "3"

2. ADJUSTMENT-IND = "0"

3. CROSSOVER-INDICATOR = "0" or is missing

STEP 3: Total long-term care days is positive

Of the claims that meet the criteria from STEP 2:

1. Create Total_LTC_Days as the sum of LEAVE-DAYS, ICF-IID-DAYS, NURSING-FACILITY-DAYS and MEDICAID-COV-INPATIENT-DAYS

2. Keep claims with Total_LTC_Days > 0

STEP 4: Sum total LTC days

Sum Total_LTC_Days for all claims in STEP 3

STEP 5: Calculate the average for measure

Divide the sum from STEP 4 by the count of claims from STEP 3