EL-3-033-42

Data Quality Measure

Last updated

Key Information

Measure Name	% of MSIS IDs with ELIGIBILITY-GROUP = 11 (Individuals Receiving SSI) without full benefits
File Type	ELG
Measure ID	EL-3-033-42
Measure Type	Non-Claims Percentage
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	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	RESTRICTED-BENEFITS-CODE • MSIS-IDENTIFICATION-NUM • ELIGIBILITY-GROUP
DD Data Element Number	ELG097 • ELG082 • ELG087

Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "11" that are not receiving full benefits
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: ELIGIBILITY-GROUP = "11" Of the MSIS IDs that meet criteria from STEP 2, futher refine the population by keeping records with ELIGIBILITY-GROUP = "11" STEP 4: Enrollees without full benefits Of the MSIS ID's that meet the criteria from STEP 3, further refine the population by keeping records that satisfy the following criteria: 1. RESTRICTED-BENEFITS-CODE is not ("1", "4", "5" "7", "A", "B", "D") OR 2. RESTRICTED-BENEFITS-CODE is missing STEP: 5: Calculate percentage for measure DIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 3

Annotation

Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "11" that are not receiving full benefits

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: ELIGIBILITY-GROUP = "11"

Of the MSIS IDs that meet criteria from STEP 2, futher refine the population by keeping records with ELIGIBILITY-GROUP = "11"

STEP 4: Enrollees without full benefits

Of the MSIS ID's that meet the criteria from STEP 3, further refine the population by keeping records that satisfy the following criteria:

1. RESTRICTED-BENEFITS-CODE is not ("1", "4", "5" "7", "A", "B", "D")

OR

2. RESTRICTED-BENEFITS-CODE is missing

STEP: 5: Calculate percentage for measure

DIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 3

Published Date	Data Guide Version	DQM	Action	Field	Before	After
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Priority	N/A	High
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Category	N/A	Beneficiary eligibility
02/26/2025	3.34.0	EL-3-033-42	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	EL-3-033-42	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Ta min		0
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Ta max		0.05
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Threshold minimum	TBD	0
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Threshold maximum	TBD	0.05
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Annotation	N/A	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "11" that are not receiving full benefits
02/26/2025	3.34.0	EL-3-033-42	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: ELIGIBILITY-GROUP = "11"Of the MSIS IDs that meet criteria from STEP 2, futher refine the population by keeping records with ELIGIBILITY-GROUP = "11"STEP 4: Enrollees without full benefitsOf the MSIS ID's that meet the criteria from STEP 3, further refine the population by keeping records that satisfy the following criteria:1. RESTRICTED-BENEFITS-CODE is not ("1", "4", "5" "7", "A", "B", "D") OR2. RESTRICTED-BENEFITS-CODE is missingSTEP: 5: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 3
06/19/2024	3.27.0	EL-3-033-42	ADD	N/A		Created