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TMSIS Dataguide Medicaid.gov
Version 3.38.0

EL-6-041-41

Data Quality Measure
Last updated

Key Information

Measure Name % of MSIS IDs enrolled in the past year with at least three gaps in enrollment over that time
File Type ELG
Measure ID EL-6-041-41
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 0.05
TA Minimun 0
TA Maximum 0.05
Longitudinal Threshold N/A
For TA
(for including in compliance training)
TA- Inferential
For TA
(Longitudinal)
No

Data Elements

DD Data Element ENROLLMENT-EFF-DATE • ENROLLMENT-END-DATE • ENROLLMENT-TYPE • MSIS-IDENTIFICATION-NUM
DD Data Element Number ELG253ELG254ELG252ELG251

Annotation Calculate the percentage of MSIS IDs enrolled in the past 12 months with at least three gaps 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: Non-duplicate enrollment spans

Duplicate records are dropped if the following three data elements are the same: MSIS-IDENTIFICATION-NUM, ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE



STEP 4: Sort records chronologically for each MSIS ID

For each MSIS ID identified in STEP 2, sort records chronologically by ENROLLMENT-EFF-DATE and ENROLLMENT-END-DATE



STEP 5: Maximum enrollment end date thus far

For each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Max_End_Date_Thus_Far = the maximum value for ENROLLMENT-END-DATE for that combination



STEP 6: Total record count by MSIS ID

For each MSIS ID identified in STEP 2, set Tot_Rec = Count of unique combinations of ENROLLMENT-EFF-DATE and ENROLLMENT-END-DATE



STEP 7: Previous enrollment end date

For each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Prev_Enrollment_End_Date = the ENROLLMENT-END-DATE value immediately prior to the ENROLLMENT-END-DATE value for that combination



STEP 8: Enrollment span start

For each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Enrollment_Span_Start = "1" as follows:

1a. Tot_Rec = 1 for the MSIS ID

OR

1b. ENROLLMENT-EFF-DATE is greater than Prev_Enrollment_End_Date

ELSE

Set Enrollment_Span_Start = "0"



STEP 9: Total count of noncontiguous enrollment spans

For each MSIS ID that meets the criteria from STEP 2, set Tot_Enrollment_Span = Count of rows where Enrollment_Span_Start = "1"



STEP 10: Count of MSIS IDs with three or more enrollment gaps

For each MSIS ID that meets the criteria from STEP 2, further refine the population by keeping records where Tot_Enrollment_Span is greater than 3. Note that since gaps exist between enrollment spans, there must be at least 4 noncontiguous enrollment spans to equal 3 enrollment gaps for a given MSIS ID.



STEP 11: Calculate percentage for measure

Divide the count of MSIS IDs from STEP 10 by the count of MSIS IDs from STEP 2