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Measure Name | % of MSIS IDs with ELIGIBILITY-GROUP = 72 (adult group - newly eligible for all states) if the state did not report MBES enrollment for this group |
---|---|
File Type | ELG |
Measure ID | EL-3-017-22 |
Measure Type | Non-claims percentage |
Content area | ELG |
Validation Type | Inferential |
---|
Measure Priority | High |
---|---|
Focus Area | Enrollment monitoring |
Category | Beneficiary eligibility |
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 | MSIS-IDENTIFICATION-NUM • SUBMITTING-STATE • ELIGIBILITY-GROUP |
---|---|
DD Data Element Number | ELG082 • ELG080 • ELG087 |
Annotation | Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "72" for states NOT expected to report this value according to public MBES enrollment data on Medicaid.gov |
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Specification |
STEP 1: Measure applies to submitting state 1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "72" because there are NO enrollees in the “VIII group eligible” category in the MBES enrollment data, proceed to STEP 2 ELSE 1b. If submitting state is expected to report ELIGIBILITY-GROUP value "72" because there are enrollees in the “VIII group eligible” category in the public MBES enrollment data on Medicaid.gov, the final measure statistic will be displayed as "N/A" STEP 2: 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 3: Eligibility determinants on the last day of DQ report month Using the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria: 1. PRIMARY-ELIGIBILITY-GROUP-IND = 1 2a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month 3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missing OR 2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing 3b. ELIGIBILITY-DETERMINANT-END-DATE is missing STEP 4: MSIS IDs with eligibility group 72 Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "72" STEP 5: Calculate percentage Divide the count from STEP 4 by the count from STEP 2 |