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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

EL-3-017-22

Data Quality Measure
Last updated

Key Information

Measure Name % of MSIS IDs with ELIGIBILITY-GROUP = 72 (adult group - newly eligible for all states) if the state did not report MBES enrollment for this group
File Type ELG
Measure ID EL-3-017-22
Measure Type Non-claims percentage
Content area ELG

Validation

Validation Type Inferential

Measure Priority

Measure Priority High
Focus Area Enrollment monitoring
Category Beneficiary eligibility

Claim Information

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

Thresholds

Minimum 0
Maximum 0
TA Minimun 0
TA Maximum 0
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element ELIGIBILITY-GROUP • SUBMITTING-STATE • MSIS-IDENTIFICATION-NUM
DD Data Element Number ELG087 • ELG080 • ELG082

Annotation Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "72" for states NOT expected to report this value according to public MBES enrollment data on Medicaid.gov
Specification STEP 1: Measure applies to submitting state

1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "72" because there are NO enrollees in the “VIII group eligible” category in the MBES enrollment data, proceed to STEP 2

ELSE

1b. If submitting state is expected to report ELIGIBILITY-GROUP value "72" because there are enrollees in the “VIII group eligible” category in the public MBES enrollment data on Medicaid.gov, the final measure statistic will be displayed as "N/A"



STEP 2: 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 3: Eligibility determinants on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 2, 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 4: MSIS IDs with eligibility group 72

Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "72"



STEP 5: Calculate percentage

Divide the count from STEP 4 by the count from STEP 2