Official websites use .gov
A
.gov website belongs to an official government
organization in the United States.
Secure .gov websites use HTTPS
A
lock () or https:// means you've safely connected to
the .gov website. Share sensitive information only on official,
secure websites.
Measure Name | % of MSIS IDs enrolled in the past year with at least one gap in enrollment over that time |
---|---|
File Type | ELG |
Measure ID | EL-6-040-40 |
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 | 0.001 |
---|---|
Maximum | 0.1 |
TA Minimun | 0.001 |
TA Maximum | 0.1 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | ENROLLMENT-EFF-DATE • ENROLLMENT-TYPE • MSIS-IDENTIFICATION-NUM • ENROLLMENT-END-DATE |
---|---|
DD Data Element Number | ELG253 • ELG252 • ELG251 • ELG254 |
Annotation | Calculate the percentage of MSIS IDs enrolled in the past 12 months with at least one gap in enrollment during that time period |
---|---|
Specification |
STEP 1: Enrolled at any time within the past 12 months 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 >= 12 months prior to last day of the DQ report month OR missing 3. MSIS-IDENTIFICATION-NUM is not missing STEP 2: Enrollment Type is Medicaid or CHIP Using the MSIS IDs that meet the criteria from STEP 1, further refine the population by keeping records with: 1. ENROLLMENT-TYPE = "1" or "2" STEP 3: Enrollment status by month Using the MSIS IDs that meet the criteria from STEP 2, for each month within the 12 month period identified in STEP 1, set Enrollment_Status = "1" where: 1. ENROLLMENT-EFF-DATE <= first day of the month 2. ENROLLMENT-END-DATE >= last day of the month OR missing ELSE Set Enrollment_Status = "0" STEP 4: Identify enrollment gaps For each month within the 12 month period identified in STEP 1, set Enrollment_Gap = "1" where: 1. Enrollment_Status = "0" for the month 2. There is any prior month within the 12 month period with Enrollment_Status = "1" 3. There is any subsequent month within the 12 month period with Enrollment_Status = "1" ELSE Set Enrollment_Gap = "0" STEP 5: Address multi-month enrollment gaps by keeping the enrollment gap status only for the earliest month For the months identified in STEP 4 where Enrollment_Status = "1", if the preceding month in the 12 month period also has Enrollment_Status = "1", set Enrollment_Status for the month = "0" STEP 6: Total count of enrollment gaps across 12 month period For each MSIS ID that meets the criteria from STEP 2, set Gap_Total = Count of months where Enrollment_Gap = "1" STEP 7: Count of MSIS IDs with an enrollment gap For each MSIS ID that meets the criteria from STEP 2, further refine the population by keeping records where Gap_Total is greater than 0 STEP 8: Calculate percentage for measure Divide the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 2 |