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TMSIS Dataguide Medicaid.gov
Version 3.27.0

EL-3-027-36

Data Quality Measure
Last updated

No Updates

Key Information

Measure Name % of MSIS IDs with ELIGIBILITY-GROUP = 12 (Aged, Blind and Disabled Individuals in 209(b) States) if the state is not a 209(b) state
File Type ELG
Measure ID EL-3-027-36
Measure Type Non-Claims Percentage
Content area ELG

Validation

Validation Type 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
Maximum 0
TA Minimun 0
TA Maximum 0
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 • SUBMITTING-STATE • ELIGIBILITY-GROUP
DD Data Element Number ELG082 • ELG080 • ELG087

Annotation Calculate the percentage of MSIS IDs with with an ELIGIBILITY-GROUP value of "12" for states that are not 209(b) states
Specification STEP 1: Measure applies to submitting state

1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "12" because the state is NOT a 209(b) state, proceed to STEP 2.

ELSE

1b. If submitting state is expected to report ELIGIBILITY-GROUP value "12" because the state is a 209(b) state, the final measure statistic will be displayed as "N/A".



STEP 2: 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 3: Eligibility determinants on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 2, 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 4: MSIS IDs with eligibility group 12

Of the MSIS IDs that meet the criteria from STEP 3, keep those where ELIGIBILITY-GROUP = "12"



STEP 5: Calculate percentage

Divide the count of unique MSIS IDs from STEP 4 by the count from STEP 2