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TMSIS Dataguide Medicaid.gov
Version 3.28.0

EL-3-007-4

Data Quality Measure
Last updated

No Updates

Key Information

Measure Name Pregnant Women (PW): % of MSIS IDs in ELIGIBILITY-GROUP = 05, 53, 67 or 68 (PW groups) with Age 13-64
File Type ELG
Measure ID EL-3-007-4
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 0.95
Maximum 1
TA Minimun 0.85
TA Maximum 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 • ELIGIBILITY-GROUP
DD Data Element Number ELG082 • ELG087

Annotation Calculate the percentage of pregnant women that are between the ages of 13 and 64
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 Pregnant Women

Of the MSIS IDs that meet the criteria from STEP 2, select pregnant women:

1. ELIGIBILITY-GROUP = "05" or "53" or "67" or "68"

2. Remove any duplicates, so each MSIS ID only appears once.



STEP 4: Primary demographics on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 3, 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 5: Calculate Age

Of the MSIS IDs that meet the criteria from STEP 4, 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.



STEP 6: Pregnant Women Aged 13-64

MERGE MSIS IDs from STEP 3 and 5 and only keep the matches and make sure there is still only one observation per MSIS ID. Then, select women with ages between 13 and 64: Age >= 13 and Age <=64.



STEP 7: Calculate percentage for measure

DIVIDE the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 3