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Measure Name | % of full duals (DUAL-ELIGIBLE-CODE = 02, 04, and 08) receiving private health insurance (TPL-HEALTH-INSURANCE = 1) |
---|---|
File Type | ELG |
Measure ID | EL-11-001-1 |
Measure Type | Non-Claims Percentage |
Content area | ELG MULTI TPL TPL |
Validation Type | Inferential |
---|
Measure Priority | Medium |
---|---|
Focus Area | N/A |
Category | Program participation |
Claim Type | N/A |
---|---|
Adjustment Type | N/A |
Crossover Type | N/A |
Minimum | 0 |
---|---|
Maximum | 0.5 |
TA Minimun | 0 |
TA Maximum | 0.6 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | MSIS-IDENTIFICATION-NUM • DUAL-ELIGIBLE-CODE • TPL-HEALTH-INSURANCE-COVERAGE-IND |
---|---|
DD Data Element Number | ELG082 • ELG085 • TPL020 |
Annotation | Compute the percentage of full dual-eligibles receiving private insurance |
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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: Unique Full Duals Of the MSIS IDs that meet the criteria from STEP 2, further refine the population using: 1. DUAL-ELIGIBLE-CODE = “02” or “04” or “08” STEP 4: TPL eligible person on the last day of DQ report month Using the MSIS IDs that meet the criteria from STEP 3, join to segment TPL-MEDICAID-ELIGIBLE-PERSON-MAIN-TPL00002 by keeping active records that satisfy the following criteria: 1a. ELIG-PRSN-MAIN-EFF-DATE <= last day of the DQ report month 2a. ELIG-PRSN-MAIN-END-DATE >= last day of the DQ report month OR missing OR 1b. ELIG-PRSN-MAIN-EFF-DATE is missing 2b. ELIG-PRSN-MAIN-END-DATE is missing STEP 5: Private health insurance Of the MSIS IDs that meet the criteria from STEP 4, select those with private insurance: 1. TPL-HEALTH-INSURANCE-COVERAGE-IND = "1" STEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3 |