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Measure Name | % of MSIS IDs with ELIGIBILITY-GROUP = 11 (Individuals Receiving SSI) without full benefits |
---|---|
File Type | ELG |
Measure ID | EL-3-033-42 |
Measure Type | Non-Claims Percentage |
Content area | ELG |
Validation Type | Inferential |
---|
Measure Priority | High |
---|---|
Focus Area | N/A |
Category | Beneficiary eligibility |
Claim Type | N/A |
---|---|
Adjustment Type | N/A |
Crossover Type | N/A |
Minimum | 0 |
---|---|
Maximum | 0.05 |
TA Minimun | 0 |
TA Maximum | 0.05 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | RESTRICTED-BENEFITS-CODE • MSIS-IDENTIFICATION-NUM • ELIGIBILITY-GROUP |
---|---|
DD Data Element Number | ELG097 • ELG082 • ELG087 |
Annotation | Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "11" that are not receiving full benefits |
---|---|
Specification |
STEP 1: 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 2: Eligibility determinants on the last day of DQ report month Using the MSIS IDs that meet the criteria from STEP 1, 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 3: ELIGIBILITY-GROUP = "11" Of the MSIS IDs that meet criteria from STEP 2, futher refine the population by keeping records with ELIGIBILITY-GROUP = "11" STEP 4: Enrollees without full benefits Of the MSIS ID's that meet the criteria from STEP 3, further refine the population by keeping records that satisfy the following criteria: 1. RESTRICTED-BENEFITS-CODE is not ("1", "4", "5" "7", "A", "B", "D") OR 2. RESTRICTED-BENEFITS-CODE is missing STEP: 5: Calculate percentage for measure DIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 3 |