An official website of the United States government

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.

TMSIS Dataguide Medicaid.gov
Version 3.38.0

EL-6-040-40

Data Quality Measure
Last updated

Key Information

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

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 0.001
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

Data Elements

DD Data Element ENROLLMENT-EFF-DATE • ENROLLMENT-TYPE • MSIS-IDENTIFICATION-NUM • ENROLLMENT-END-DATE
DD Data Element Number ELG253ELG252ELG251ELG254

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