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Measure Name | % of MSIS IDs in S-CHIP reported without an S-CHIP Eligibility Group |
---|---|
File Type | ELG |
Measure ID | EL-3-021-26 |
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 | 0.05 |
TA Minimun | 0 |
TA Maximum | 0.05 |
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 S-CHIP eligibles that are not enrolled in an S-CHIP eligibility group |
---|---|
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: CHIP code value indicates S-CHIP enrollment Of the MSIS IDs that meet the criteria from STEP 2, further restrict to MSIS IDs where: 1. CHIP-CODE = "3" 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: Individuals not enrolled in an S-CHIP eligibility group Of the MSIS IDs that meet the criteria from STEP 4, further restrict to MSIS IDs where: 1a. ELIGBILITY-GROUP not equal to (“61” or “62” or “63” or “64” or “65” or “66” or “67” or “68”) OR 1b. ELIGIBILITY-GROUP is missing STEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3 |