EL-6-022-22

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TMSIS Dataguide

Medicaid.gov

Version:

EL-6-022-22

Data Quality Measure

Last updated

Key Information

Measure Name	Family Planning (FP): % MSIS IDs with FP-waivers (WAIVER TYPE = 24) that have RESTRICTED-BENEFIT-CODE = 6 (FP)
File Type	ELG
Measure ID	EL-6-022-22
Measure Type	Non-Claims Percentage
Content area	ELG

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	N/A
Focus Area	N/A
Category	N/A

Claim Information

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

Thresholds

Minimum	0.9
Maximum	1
TA Minimun
TA Maximum
Longitudinal Threshold	N/A
For TA (for including in compliance training)	No
For TA (Longitudinal)	No

Data Elements

DD Data Element	MSIS-IDENTIFICATION-NUM • WAIVER-TYPE • RESTRICTED-BENEFITS-CODE
DD Data Element Number	ELG171 • ELG173 • ELG097

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
04/21/2023	3.6.0	EL-6-022-22	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	EL-6-022-22	UPDATE	Category	Program participation	N/A
04/21/2023	3.6.0	EL-6-022-22	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	EL-6-022-22	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	EL-6-022-22	UPDATE	Ta min	0.9
04/21/2023	3.6.0	EL-6-022-22	UPDATE	Ta max	1
04/21/2023	3.6.0	EL-6-022-22	UPDATE	Annotation	Calculate the percentage of Family Planning waiver eligibles with restricted benefit code equal to 6	N/A
04/21/2023	3.6.0	EL-6-022-22	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 month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Waiver participation on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment WAIVER-PARTICIPATION-ELG00012 by keeping records that satisfy the following criteria:1a. WAIVER-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. WAIVER-ENROLLMENT-EFF-DATE is missing2b. WAIVER-ENROLLMENT-END-DATE is missingSTEP 3: Family planning waiver participantsOf the MSIS IDs that meet the criteria from STEP 2, select family planning waiver participants:1. WAIVER-TYPE = "24"2. Remove any duplicates, so each MSIS ID only appears once.STEP 4: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, 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 5: Restricted benefits codeOf the MSIS IDs which meet the criteria from STEP 4, restrict to:1. RESTRICTED-BENEFITS-CODE = "6"STEP 6: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 5 by the count of MSIS IDs from STEP 3.	N/A