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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

EL-3-033-42

Data Quality Measure
Last updated

Key Information

Measure Name % of MSIS IDs with ELIGIBILITY-GROUP = 11 (Individuals Receiving SSI) without full benefits
File Type ELG
Measure ID EL-3-033-42
Measure Type Non-Claims Percentage
Content area ELG

Validation

Validation Type Inferential

Measure Priority

Measure Priority High
Focus Area N/A
Category Beneficiary eligibility

Claim Information

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

Thresholds

Minimum 0
Maximum 0.05
TA Minimun 0
TA Maximum 0.05
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element ELIGIBILITY-GROUP • MSIS-IDENTIFICATION-NUM • RESTRICTED-BENEFITS-CODE
DD Data Element Number ELG087 • ELG082 • ELG097

Annotation Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "11" that are not receiving full benefits
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: ELIGIBILITY-GROUP = "11"

Of the MSIS IDs that meet criteria from STEP 2, further refine the population by keeping records with ELIGIBILITY-GROUP = "11"



STEP 4: Enrollees without full benefits

Of the MSIS ID's that meet the criteria from STEP 3, further refine the population by keeping records that satisfy the following criteria:

1. RESTRICTED-BENEFITS-CODE is not ("1", "4", "5" "7", "A", "B", "D")

OR

2. RESTRICTED-BENEFITS-CODE is missing



STEP: 5: Calculate percentage for measure

DIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 3