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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 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