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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

EL-6-025-25

Data Quality Measure
Last updated

Key Information

Measure Name % family planning (RESTRICTED-BENEFITS-CODE = 6) with non-family planning eligibility group
File Type ELG
Measure ID EL-6-025-25
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
Maximum 0.05
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 • RESTRICTED-BENEFITS-CODE • ELIGIBILITY-GROUP
DD Data Element Number ELG082 • ELG097 • ELG087

Annotation Calculate the percentage of family planning restricted benefit eligibles that do not have a family planning eligibility group
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: Family planning restricted benefit eligibles

Of the MSIS IDs which meet the criteria from STEP 3, restrict to those with family planning:

1. RESTRICTED-BENEFITS-CODE = "6"



STEP 4: Non-family planning eligibility group

Of the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:

1. ELIGIBILITY-GROUP not equal to ("35" or "70") or missing



STEP 5: Calculate percentage

Divide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3