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TMSIS Dataguide Medicaid.gov
Version 3.27.0

EL-3-003-11

Data Quality Measure
Last updated

No Updates

Key Information

Measure Name % of MSIS IDs with age 65+ that are duals
File Type ELG
Measure ID EL-3-003-11
Measure Type Non-Claims Percentage
Content area ELG

Validation

Validation Type Longitudinal and inferential

Measure Priority

Measure Priority High
Focus Area N/A
Category Beneficiary eligibility

Claim Information

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

Thresholds

Minimum 0.85
Maximum 1
TA Minimun 0.75
TA Maximum 1
Longitudinal Threshold 0.05
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 ELG019 • ELG085

Annotation Calculate the percentage of eligibles 65 and older who are dual eligibles
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: Primary demographics on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:

1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month

2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missing

OR

1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing

2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missing



STEP 3: Calculate Age

Of the MSIS IDs that meet the criteria from STEP 2, calculate age:

1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.

1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH.

Note: Perform calculations to count full years (e.g., 5/1/2015 – 8/1/1950 = 64)



STEP 4: Age 65 and older

Of the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping records with age >=65



STEP 5: Eligibility determinants on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 4, 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 6: Dual eligible

Of the MSIS IDs that meet the criteria from STEP 5, further refine the population using DUAL-ELIGIBLE-CODE=“01” or “02” or “03” or “04” or “05” or “06” or “08” or “09” or “10”



STEP 7: Calculate percentage for measure

DIVIDE the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 4