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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

EL-6-028-28

Data Quality Measure
Last updated

Key Information

Measure Name % of record segments with an invalid waiver ID format for 1115 waivers (WAIVER-TYPE = 01 or 21 - 30)
File Type ELG
Measure ID EL-6-028-28
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 0.01
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 WAIVER-TYPE • WAIVER-ID
DD Data Element Number ELG173 • ELG172

Annotation Calculate the percentage of rows in the ELG00012 segment with an 1115 waiver type that have a waiver ID in an invalid format
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: Waiver participation on the last day of DQ report month

Using 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 month

2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missing

OR

1b. WAIVER-ENROLLMENT-EFF-DATE is missing

2b. WAIVER-ENROLLMENT-END-DATE is missing



STEP 3: 1115 waiver type

Of the record segments that meet the criteria from STEP 2, keep those that satisfy the following criteria:

1. WAIVER-TYPE = "01" or ("21" - "30")



STEP 4: Invalid waiver ID values

Of the record segments that meet the criteria from STEP 3, define invalid WAIVER-ID values by counting the number of segments that meet the following criteria:

1. WAIVER-ID does not begin with (“11-W-“ OR “21-W-“)

OR

2. WAIVER-ID does not contain [0-9] in positions 6-10 and 12 to end

OR

3. WAIVER-ID position 11 is not "/"

OR

4. WAIVER-ID is missing



STEP 5: Calculate percentage

Divide the count of record segments from STEP 4 by the count of record segments from STEP 3