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Measure Name | % of Medicaid MSIS IDs with a CHIP Eligibility Group |
---|---|
File Type | ELG |
Measure ID | EL-3-013-18 |
Measure Type | Non-Claims Percentage |
Content area | ELG |
Validation Type | Inferential |
---|
Measure Priority | High |
---|---|
Focus Area | N/A |
Category | Beneficiary eligibility |
Claim Type | N/A |
---|---|
Adjustment Type | N/A |
Crossover Type | N/A |
Minimum | 0 |
---|---|
Maximum | 0.01 |
TA Minimun | 0 |
TA Maximum | 0.01 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | MSIS-IDENTIFICATION-NUM • CHIP-CODE • ELIGIBILITY-GROUP |
---|---|
DD Data Element Number | ELG033 • ELG054 • ELG087 |
Annotation | Calculate the percentage of unique MSIS IDs classified as Medicaid with an eligibility group indicator associated with it |
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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: Variable demographics on the last day of DQ report month Using the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria: 1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month 2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missing OR 1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing 2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missing STEP 3: Medicaid enrollees Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria: 1. CHIP-CODE="1" STEP 4: Eligibility determinants on the last day of DQ report month Using the MSIS IDs that meet the criteria from STEP 3, 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 5: CHIP eligibility group Of the MSIS IDs that meet the criteria from STEP 3, keep the MSIS IDs that satisfy the following criteria: 1. ELIGIBILITY-GROUP = ("61", "62", "63, "64", "65", "66", "67", or "68") STEP 6: Percentage Divide the count of unique MSIS IDs from STEP 5 by the count in STEP 3 |