FFS-5-011-29

Data Quality Measure

Last updated

Key Information

Measure Name	Average # of long-term care days, exclude 0
File Type	CLT
Measure ID	FFS-5-011-29
Measure Type	Average
Content area	FFS

Validation

Validation Type	Longitudinal and Inferential

Measure Priority

Measure Priority	Medium
Focus Area	N/A
Category	Utilization

Claim Information

Claim Type	Medicaid,FFS
Adjustment Type	Original
Crossover Type	Non-Crossover

Thresholds

Minimum	7
Maximum	31
TA Minimun	5
TA Maximum	40
Longitudinal Threshold	0.15
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	NURSING-FACILITY-DAYS • MEDICAID-COV-INPATIENT-DAYS • LEAVE-DAYS • ICF-IID-DAYS
DD Data Element Number	CLT149 • CLT086 • CLT148 • CLT147

Annotation	Average number of long-term care days (exclude 0) for Medicaid FFS: original, non-crossover, paid LT claims
Specification	STEP 1: Active non-duplicate paid LT claims during report month Define the LT claims universe at the header level that satisfy the following criteria: 1. Reporting Period from the filename = DQ report month 2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing 3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing 4. TYPE-OF-CLAIM is not equal to "Z" or is missing 5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing 6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 2: Medicaid FFS: Original, Non-Crossover, Paid Claims Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria: 1. TYPE-OF-CLAIM = "1" 2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missing STEP 3: Total long-term care days is positive Of the claims that meet the criteria from STEP 2: 1. Create Total_LTC_Days as the sum of LEAVE-DAYS, ICF-IID-DAYS, NURSING-FACILITY-DAYS and MEDICAID-COV-INPATIENT-DAYS 2. Keep claims with Total_LTC_Days > 0 STEP 4: Sum total LTC days Sum Total_LTC_Days for all claims in STEP 3 STEP 5: Calculate the average for measure Divide the sum from STEP 4 by the count of claims from STEP 3

Annotation

Average number of long-term care days (exclude 0) for Medicaid FFS: original, non-crossover, paid LT claims

Specification

STEP 1: Active non-duplicate paid LT claims during report month

Define the LT claims universe at the header level that satisfy the following criteria:

1. Reporting Period from the filename = DQ report month

2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing

3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing

4. TYPE-OF-CLAIM is not equal to "Z" or is missing

5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing

6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.

STEP 2: Medicaid FFS: Original, Non-Crossover, Paid Claims

Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria:

1. TYPE-OF-CLAIM = "1"

2. ADJUSTMENT-IND = "0"

3. CROSSOVER-INDICATOR = "0" or is missing

STEP 3: Total long-term care days is positive

Of the claims that meet the criteria from STEP 2:

1. Create Total_LTC_Days as the sum of LEAVE-DAYS, ICF-IID-DAYS, NURSING-FACILITY-DAYS and MEDICAID-COV-INPATIENT-DAYS

2. Keep claims with Total_LTC_Days > 0

STEP 4: Sum total LTC days

Sum Total_LTC_Days for all claims in STEP 3

STEP 5: Calculate the average for measure

Divide the sum from STEP 4 by the count of claims from STEP 3