ELG.012.173

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TMSIS Dataguide

Medicaid.gov

Version:

WAIVER-TYPE

Data Element

DE Number

ELG173

System DE Number

ELG.012.173

File Name

File Segment Number

File Segment Name

WAIVER-PARTICIPATION

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Code for specifying waiver types under which the eligible individual is covered during the month.
Size	X(2)
FLF Start Position	62
FLF Stop Position	63
Segment Key Field Identifier	4
Coding Requirements	1. Value must be 2 characters 2. Value must be in Waiver Type List (VVL) 3. Value must have a corresponding value in Waiver ID (ELG.012.172) 4. Mandatory

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-2334	If the waiver type is populated on a waiver participation file, then the waiver type reported must be found in the list of valid values.
RULE-6497	If a segment is a waiver participation segment from an ELG file, then the waiver type value reported must be compatible with the specified T-MSIS picture format: X(2).
RULE-7427	If a segment is a waiver participation segment from an ELG file, and the waiver participation segment has a family planning demonstration waiver type and the effective and end dates on the waiver participation segment fall within the effective and end dates of one or more continuous eligibility determinants segments, and the eligibility determinants has a primary eligibility group indicator equal to '1', then the restricted benefits code is equal to '6'.
RULE-7770	If a claim is a non-denied claim from an IP file, and the waiver type is populated, and the claim admission date is between the waiver enrollment effective and end dates, then the claim waiver type is equal to the waiver participation waiver type.
RULE-7771	If a claim is a non-denied claim from an LT file, and the waiver type is populated, and the claim beginning date of service is between the waiver enrollment effective and end dates, then the claim waiver type is equal to the waiver participation waiver type.
RULE-7772	If a claim is a non-denied claim from an OT file, and the waiver type is populated, and the claim beginning date of service is between the waiver enrollment effective and end dates, then the claim waiver type is equal to the waiver participation waiver type.
RULE-7773	If a claim is a non-denied claim from an RX file, and the waiver type is populated, and the claim prescription fill date is between the waiver enrollment effective and end dates, then the claim waiver type is equal to the waiver participation waiver type.

Measure ID	Measure Name
ALL-2-007-7	OT- % of active 1915(c) eligibles (WAIVER-TYPE = '06' - '20' or ‘33’) during the reporting period with 1915(c) claim records (HCBS-SERVICE-CODE = '5')
ALL-2-008-8	OT- % of 1915(c) or 1915(i) eligibles (WAIVER-TYPE = '06' - '20' or ‘33’ or STATE-PLAN-OPTION-TYPE = '02') with HCBS-TAXONOMY claims
MIS-1-064-64	% distinct MSIS IDs with only missing values in any active segment: WAIVER-TYPE (ELG00012)
EL-6-022-22	Family Planning (FP): % MSIS IDs with FP-waivers (WAIVER TYPE = 24) that have RESTRICTED-BENEFIT-CODE = 6 (FP)
EL-6-028-28	% of record segments with an invalid waiver ID format for 1115 waivers (WAIVER-TYPE = 01 or 21 - 30)
ALL-2-009-9	% of 1915(c) waiver enrollees (WAIVER-TYPE = 06 - 20 or 33) that do not have any claim headers with the corresponding waiver ID
ALL-2-010-10	% of 1915(c) waiver enrollees (WAIVER-TYPE = 06 - 20 or 33) that do not have any claim headers with PROGRAM-TYPE = 07
ALL-2-011-11	% of 1915(c) waiver enrollees (WAIVER-TYPE = 06 - 20 or 33) that do not have any claim headers with HCBS-SERVICE-CODE = 4
EL-6-029-29	% of record segments with an invalid waiver ID format for 1915(b) and 1915(c) waivers (WAIVER-TYPE = 02 - 20, 32, or 33)
RULE-7458	% of record segments with an invalid waiver ID format for 1115 waivers (WAIVER-TYPE = 01 or 21 - 30)
RULE-7459	% of record segments with an invalid waiver ID format for 1915(b) and 1915(c) waivers (WAIVER-TYPE = 02 - 20, 32, or 33)
RULE-7427	Family Planning (FP): % of FP-waiver segments (WAIVER TYPE = 24) that do not have RESTRICTED-BENEFITS-CODE = 6 (FP)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP177	CIP.002.177	WAIVER-TYPE	CIP00002	CLAIM-HEADER-RECORD-IP
CLT128	CLT.002.128	WAIVER-TYPE	CLT00002	CLAIM-HEADER-RECORD-LT
COT110	COT.002.110	WAIVER-TYPE	COT00002	CLAIM-HEADER-RECORD-OT
CRX068	CRX.002.068	WAIVER-TYPE	CRX00002	CLAIM-HEADER-RECORD-RX
FTX050	FTX.002.050	WAIVER-TYPE	FTX00002	INDIVIDUAL-CAPITATION-PMPM
FTX095	FTX.003.095	WAIVER-TYPE	FTX00003	INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT
FTX139	FTX.004.139	WAIVER-TYPE	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT
FTX181	FTX.005.181	WAIVER-TYPE	FTX00005	COST-SHARING-OFFSET
FTX223	FTX.006.223	WAIVER-TYPE	FTX00006	VALUE-BASED-PAYMENT
FTX268	FTX.007.268	WAIVER-TYPE	FTX00007	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX308	FTX.008.308	WAIVER-TYPE	FTX00008	COST-SETTLEMENT-PAYMENT
FTX347	FTX.009.347	WAIVER-TYPE	FTX00009	FQHC-WRAP-PAYMENT
FTX395	FTX.095.395	WAIVER-TYPE	FTX00095	MISCELLANEOUS-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
12/19/2024	4.0.1	ELG.012.173	UPDATE	Segment key field identifier	Not Applicable	4
09/16/2024	4.0.0	ELG.012.173	UPDATE	File segment	None	55
09/16/2024	4.0.0	ELG.012.173	ADD	N/A		Created