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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 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 |
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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 | ENROLLMENT-EFF-DATE • ENROLLMENT-END-DATE • ENROLLMENT-TYPE • MSIS-IDENTIFICATION-NUM |
---|---|
DD Data Element Number | ELG253 • ELG254 • ELG252 • ELG251 |
Annotation | Calculate the percentage of MSIS IDs enrolled in the past 12 months with at least three gaps in enrollment during that time period |
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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 |