EL-3-002-7

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Measure Name	% of MSIS IDs in ELIGIBILITY-GROUP = 23 through 26 (QMB, QDWI, SLMB or QI) with valid DUAL-ELIGIBLE-CODE 01 through 10
File Type	ELG
Measure ID	EL-3-002-7
Measure Type	Non-Claims Percentage
Content area	ELG

Validation Type	Inferential

Measure Priority	N/A
Focus Area	N/A
Category	N/A

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

Minimum	0.95
Maximum	1
TA Minimun
TA Maximum
Longitudinal Threshold	N/A
For TA (for including in compliance training)	No
For TA (Longitudinal)	No

DD Data Element	MSIS-IDENTIFICATION-NUM • ELIGIBILITY-GROUP • DUAL-ELIGIBLE-CODE
DD Data Element Number	ELG082 • ELG087 • ELG085

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
06/19/2024	3.27.0	EL-3-002-7	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	EL-3-002-7	UPDATE	Category	Beneficiary eligibility	N/A
06/19/2024	3.27.0	EL-3-002-7	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	EL-3-002-7	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	EL-3-002-7	UPDATE	Ta min	0.95
06/19/2024	3.27.0	EL-3-002-7	UPDATE	Ta max	1
06/19/2024	3.27.0	EL-3-002-7	UPDATE	Annotation	Calculate the percentage of eligibles in ELIGIBILITY-GROUP QMB, QDWI, SLMB or QI (23 through 26) with valid DUAL-ELIGIBLE CODE 01 through 10	N/A
06/19/2024	3.27.0	EL-3-002-7	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine 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 missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing 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 = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month 3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Eligibility Group: QMB, QDWI, SLMB or QIOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with ELIGIBLE-GROUP=“23” or “24” or “25” or “26” STEP 4: Dual eligibleOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping records with DUAL-ELIGIBLE-CODE=“01” or “02” or “03” or “04” or “05” or “06” or “08” or “09” or “10” STEP 5: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 3	N/A

EL-3-002-7

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements