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Measure Name | # of plans with at least 100 enrollments and some capitations that have capitation ratios outside of the expected range (0.7 - 1.3) |
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File Type | COT |
Measure ID | MCR-54-004-4 |
Measure Type | Count |
Content area | MCR |
Validation Type | Inferential |
---|
Measure Priority | High |
---|---|
Focus Area | Managed care |
Category | Expenditures |
Claim Type | N/A |
---|---|
Adjustment Type | N/A |
Crossover Type | N/A |
Minimum | 0 |
---|---|
Maximum | 0 |
TA Minimun | 0 |
TA Maximum | 0 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | PLAN-ID-NUMBER • PLAN-ID-NUMBER • PLAN-ID-NUMBER • PLAN-ID-NUMBER • MANAGED-CARE-PLAN-TYPE • STATE-PLAN-ID-NUM • MANAGED-CARE-PLAN-TYPE • MANAGED-CARE-PLAN-ID • TYPE-OF-SERVICE • ADJUSTMENT-IND • ADJUSTMENT-IND • ADJUSTMENT-IND • ADJUSTMENT-IND • TYPE-OF-CLAIM • TYPE-OF-CLAIM • TYPE-OF-CLAIM |
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DD Data Element Number | CIP130 • CLT080 • COT066 • CRX056 • MCR024 • MCR019 • ELG193 • ELG192 • COT186 • CIP026 • CLT025 • COT025 • CRX025 • CIP100 • CLT052 • COT037 |
Annotation | Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some capitation that have a capitation ratio outside of (0.7, 1.3), excluding those with plan types: 02, 03, 17, 60, 70, 99 or missing |
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Specification |
STEP 1: Exclude PCCM, PACE, Health Home, ACO, Missing Plan Types Of the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where: 1. Plan_Type_El is not equal to ("02","03", "17", "60", "70", or "99") or is missing STEP 2: Enrollment and capitation Of the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria: 1. Enrollment >= 100 2. Total_Capitation > 0 STEP 3: Capitation ratio out of expected range Of the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where: 1. Capitation_Ratio < 0.7 OR Capitation_Ratio > 1.3 |