Managed Care Plan Type Code (Using Hierarchy) - May

SAS Name

The managed care plan type: A model of health care delivery organized to provide a defined set of services in the month. There are separate variables for each of the 12 months during the year.


Only one managed care plan type is selected each month from up to 16 monthly managed care plan type codes (note that this managed care plan type code detail is contained in the DE ― Managed Care Supplemental File). A priority list, derived for the DE base file is used. The values for the monthly managed care plan type codes are set according to the hierarchy below:

1) Comprehensive Managed Care Organization (MCO)

2) Health Insuring Organization (HIO)

3) Medical-only Prepaid Inpatient Health Plan (PIHP)

4) Medical-only Prepaid Ambulatory Health Plan (PAHP)

5) Transportation PAHP

6) Long-Term Care (LTC) PIHP

7) Dental PAHP

8) Program of All-Inclusive Care for the Elderly (PACE)

9) Mental health (MH) PIHP


11) Substance use disorders (SUD) PIHP


13) MH and SUD PIHP

14) MH and SUD PAHP

15) Individual is enrolled in long-term services and supports (LTSS) and mental health (MH) PIHP

16) Pharmacy PAHP

17) Disease Management PAHP

18) Traditional Primary Care Case Management (PCCM) Provider

19) Enhanced PCCM provider

20) Accountable care organization (ACO)

21) Health/Medical home (HH)

22) Integrated care for dual eligibles

23) Other

24) Null values