EL-3-019_1-34

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TMSIS Dataguide

Medicaid.gov

Version 3.38.0

EL-3-019_1-34

Data Quality Measure

Last updated

Key Information

Measure Name	% of MSIS IDs with ELIGIBILITY-GROUP = 73, 74, or 75 (adult group - not newly eligible) if the state did not report MBES enrollment for this group
File Type	ELG
Measure ID	EL-3-019_1-34
Measure Type	Non-Claims Percentage
Content area	ELG

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	Enrollment monitoring
Category	Beneficiary eligibility

Claim Information

Claim Type	N/A
Adjustment Type	N/A
Crossover Type	N/A

Thresholds

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

Data Elements

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 "73", "74", or "75" for states NOT expected to report these values according to public MBES enrollment data on Medicaid.gov

Specification

STEP 1: Measure applies to submitting state

1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are NO enrollees in any "Not Newly Eligible" category in the MBES enrollment data, proceed to STEP 2.

ELSE

1b. If submitting state is expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are enrollees in any "Not Newly 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 73, 74, or 75

Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "73", "74", or "75"

STEP 5: Calculate percentage

Divide the count from STEP 4 by the count from STEP 2

Published Date	Data Guide Version	DQM	Action	Field	Before	After
12/18/2024	3.33.0	EL-3-019_1-34	UPDATE	Focus area	Unwinding	Enrollment monitoring
02/02/2024	3.18.0	EL-3-019_1-34	UPDATE	Focus area	N/A	Unwinding
03/10/2023	3.4.0	EL-3-019_1-34	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "73", "74", or "75" for states NOT expected to report these values according to MBES enrollment data	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "73", "74", or "75" for states NOT expected to report these values according to public MBES enrollment data on Medicaid.gov
03/10/2023	3.4.0	EL-3-019_1-34	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are NO enrollees in any "Not Newly Eligible" category in the MBES enrollment data, proceed to STEP 2.ELSE1b. If submitting state is expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are enrollees in any "Not Newly Eligible" category in the MBES enrollment data, the final measure statistic will be displayed as "N/A".STEP 2: Enrolled on the last day of DQ report monthDefine 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 missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing 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 = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 73, 74, or 75Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "73", "74", or "75"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2	STEP 1: Measure applies to submitting state1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are NO enrollees in any "Not Newly Eligible" category in the MBES enrollment data, proceed to STEP 2.ELSE1b. If submitting state is expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are enrollees in any "Not Newly 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 monthDefine 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 missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing 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 = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 73, 74, or 75Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "73", "74", or "75"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2