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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

EL-6-032-35

Data Quality Measure
Last updated

Key Information

Measure Name % of MSIS IDs with restricted benefits code designating MFP participation (RESTRICTED-BENEFITS-CODE = D) that are not found on MFP-INFORMATION-ELG00010 for the same month
File Type ELG
Measure ID EL-6-032-35
Measure Type Non-Claims Percentage
Content area ELG

Validation

Validation Type Inferential

Measure Priority

Measure Priority Medium
Focus Area N/A
Category Program participation

Claim Information

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

Thresholds

Minimum 0
Maximum 0.3
TA Minimun 0
TA Maximum 0.3
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element RESTRICTED-BENEFITS-CODE • MSIS-IDENTIFICATION-NUM • MSIS-IDENTIFICATION-NUM
DD Data Element Number ELG097 • ELG082 • ELG149

Annotation Calculate the percentage of eligibles with a restricted benefits code designating Money Follows the Person participation that are not included in the ELG00010 segment for the same month
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: Money Follows the Person participation

Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:

1. RESTRICTED-BENEFITS-CODE = “D”



STEP 4: MFP enrollment on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 3, join to segment MFP-INFORMATION-ELG00010 by keeping records that satisfy the following criteria:

1. MFP-ENROLLMENT-EFF-DATE <= last day of the DQ report month AND is not missing

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



STEP 5: No MFP Enrollment

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



STEP 6: Calculate percentage

Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3