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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

EL-6-041-41

Data Quality Measure
Last updated

Key Information

Measure Name % of MSIS IDs enrolled in the past year with at least three gaps in enrollment over that time
File Type ELG
Measure ID EL-6-041-41
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 0.05
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 ENROLLMENT-TYPE • MSIS-IDENTIFICATION-NUM • ENROLLMENT-END-DATE • ENROLLMENT-EFF-DATE
DD Data Element Number ELG252 • ELG251 • ELG254 • ELG253

Annotation Calculate the percentage of MSIS IDs enrolled in the past 12 months with at least three gaps in enrollment during that time period
Specification STEP 1: Enrolled at any time within the past 12 months

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 >= 12 months prior to last day of the DQ report month OR missing

3. MSIS-IDENTIFICATION-NUM is not missing



STEP 2: Enrollment Type is Medicaid or CHIP

Using the MSIS IDs that meet the criteria from STEP 1, further refine the population by keeping records with:

1. ENROLLMENT-TYPE = "1" or "2"



STEP 3: Non-duplicate enrollment spans

Duplicate records are dropped if the following three data elements are the same: MSIS-IDENTIFICATION-NUM, ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE



STEP 4: Sort records chronologically for each MSIS ID

For each MSIS ID identified in STEP 2, sort records chronologically by ENROLLMENT-EFF-DATE and ENROLLMENT-END-DATE



STEP 5: Maximum enrollment end date thus far

For each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Max_End_Date_Thus_Far = the maximum value for ENROLLMENT-END-DATE for that combination



STEP 6: Total record count by MSIS ID

For each MSIS ID identified in STEP 2, set Tot_Rec = Count of unique combinations of ENROLLMENT-EFF-DATE and ENROLLMENT-END-DATE



STEP 7: Previous enrollment end date

For each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Prev_Enrollment_End_Date = the ENROLLMENT-END-DATE value immediately prior to the ENROLLMENT-END-DATE value for that combination



STEP 8: Enrollment span start

For each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Enrollment_Span_Start = "1" as follows:

1a. Tot_Rec = 1 for the MSIS ID

OR

1b. ENROLLMENT-EFF-DATE is greater than Prev_Enrollment_End_Date

ELSE

Set Enrollment_Span_Start = "0"



STEP 9: Total count of noncontiguous enrollment spans

For each MSIS ID that meets the criteria from STEP 2, set Tot_Enrollment_Span = Count of rows where Enrollment_Span_Start = "1"



STEP 10: Count of MSIS IDs with three or more enrollment gaps

For each MSIS ID that meets the criteria from STEP 2, further refine the population by keeping records where Tot_Enrollment_Span is greater than 3. Note that since gaps exist between enrollment spans, there must be at least 4 noncontiguous enrollment spans to equal 3 enrollment gaps for a given MSIS ID.



STEP 11: Calculate percentage for measure

Divide the count of MSIS IDs from STEP 10 by the count of MSIS IDs from STEP 2