EL-3-025-30

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TMSIS Dataguide

Medicaid.gov

Version:

EL-3-025-30

Data Quality Measure

Last updated

Key Information

Measure Name	# of distinct mandatory eligibility group values for SSI or ABD individuals (ELIGIBILITY-GROUP = 11 or 12)
File Type	ELG
Measure ID	EL-3-025-30
Measure Type	Count
Content area	ELG

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	N/A
Category	Beneficiary eligibility

Claim Information

Claim Type	N/A
Adjustment Type	N/A
Crossover Type	N/A

Thresholds

Minimum	1
Maximum	1
TA Minimun	1
TA Maximum	1
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	ELIGIBILITY-GROUP
DD Data Element Number	ELG087

Annotation

Count the number of mandatory eligibility groups for SSI or ABD individuals with at least one MSIS ID with a primary eligibility group indicator associated with it

Specification

STEP 1: Enrolled on the last day of DQ report month

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 >= last day of the DQ report month OR missing

3. MSIS-IDENTIFICATION-NUM is not missing

STEP 2: Eligibility determinants on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:

1. PRIMARY-ELIGIBILITY-GROUP-IND = 1

2a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month

3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missing

OR

2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing

3b. ELIGIBILITY-DETERMINANT-END-DATE is missing

STEP 3: Frequency of mandatory eligibility groups

Of the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 11, 12

STEP 4: Count of categories

Of the 2 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID

Published Date	Data Guide Version	DQM	Action	Field	Before	After
04/21/2023	3.6.0	EL-3-025-30	UPDATE	Annotation	N/A	Count the number of mandatory eligibility groups for SSI or ABD individuals with at least one MSIS ID with a primary eligibility group indicator associated with it
04/21/2023	3.6.0	EL-3-025-30	UPDATE	Specification	N/A	STEP 1: Enrolled on the last day of DQ report monthDefine 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 >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Frequency of mandatory eligibility groupsOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 11, 12STEP 4: Count of categoriesOf the 2 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID
03/10/2023	3.4.0	EL-3-025-30	UPDATE	Annotation	Count the number of mandatory eligibility groups for SSI or ABD individuals with at least one MSIS ID with a primarily eligibility group indicator associated with it	N/A
03/10/2023	3.4.0	EL-3-025-30	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine 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 >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Frequency of mandatory eligibility groupsOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 11, 12STEP 4: Count of categoriesOf the 2 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID	N/A