Key Information

Measure Name	% difference between T-MSIS QMB-only duals count and MMA QMB-only duals count (Dual Code=01)
File Type	ELG
Measure ID	EL-15-004-4
Measure Type	Non-claims percentage
Content area	ELG

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	Medium
Focus Area	N/A
Category	Beneficiary eligibility

Claim Information

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

Thresholds

Minimum	-0.1
Maximum	0.1
TA Minimun	-0.1
TA Maximum	0.1
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	MSIS-IDENTIFICATION-NUM • DUAL-ELIGIBLE-CODE
DD Data Element Number	ELG082 • ELG085

Annotation

Calculate the percent difference between the T-MSIS QMB-only duals count and the MMA QMB-only duals count

Specification

STEP 1: MMA QMB-only count Retrieve the QMB-only count from the MMA data. This is an external source. More information is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/StateMMAFile Note: The MMA count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the MMA data are ready to do the calculation, so that the MMA count and T-MSIS count are for the same month. STEP 2: QMB-only duals count Use the measure statistic from EL-6-012-12 STEP 3: Difference Subtract the count from STEP 1 from the count of dual eligible beneficiaries from STEP 2 STEP 4: Percentage Divide the difference from STEP 3 by the count in STEP 1