# Managed Long-Term Care Consumer Guide Methodology

The consumer guides use a 5-star rating to assess the quality of care across plans. A rating with more stars indicates a better quality. Consumers can view both the overall quality rating and individual domain ratings for a plan. Domains represent the quality of care for a group of people or condition and may include several measures of care relevant to the group or condition. Plan ratings are determined using a three step process:

#### 1. Standardize Measure Scores.

1. The measure set in this rating system includes nineteen measures. Measure results need to be standardized before the calculation of domain scores. Depending on the method of data collection, different statistics are used to create the standardized measure scores.
1. For survey-based measures - The Student's t-statistic is used:
Standardized Score = (plan rate - statewide rate) / Standard Error
2. For population-based measures - The Nelson's H statistic is used, which is derived from Analysis of Proportions (ANOP) methodology:
Standardized Score = (plan rate - statewide rate)/(SQRT[statewide rate * (1 - statewide rate)] * SQRT[(statewide denominator - plan denominator)/(statewide denominator * plan denominator)])

#### 2. Calculate Domain Scores and Ratings.

A domain score is the average of the standardized measure scores within the domain. Measures with denominators smaller than 30 are excluded from the respective domain score calculation. Dependant on the number of plans, the z-statistic or t-statistic of the domain scores is calculated and converted to the star rating by the percentile rank inferred from the respective z-distribution or student's t-distribution. If all measures in a domain have denominators smaller than 30, N/A appears in place of a star rating. The cut-point values for the 5-star ratings are shown in the table below.

Percentiles of Statistic Ratings
0 <= Score Value < 10 1 star
10 <= Score Value < 30 2 star
30 <= Score Value < 70 3 star
70 <= Score Value < 90 4 star
90 <= Score Value 5 star

#### 3. Calculate Overall Rating.

The overall score is the average of the stars in the domain scores. Domain ratings of N/A are assigned the statewide average of the stars for that domain. The z-statistic of the overall score is calculated and converted to the 5-star rating by the percentile rank inferred from the z-distribution. The method is the same as used in the domain ratings.