06/19/2024 |
3.27.0 |
EL-6-027-27 |
UPDATE |
Priority |
High |
N/A |
06/19/2024 |
3.27.0 |
EL-6-027-27 |
UPDATE |
Category |
Beneficiary eligibility |
N/A |
06/19/2024 |
3.27.0 |
EL-6-027-27 |
UPDATE |
For ta comprehensive |
TA- Inferential |
No |
06/19/2024 |
3.27.0 |
EL-6-027-27 |
UPDATE |
For ta inferential |
Yes |
No |
06/19/2024 |
3.27.0 |
EL-6-027-27 |
UPDATE |
Ta min |
0 |
|
06/19/2024 |
3.27.0 |
EL-6-027-27 |
UPDATE |
Ta max |
0.01 |
|
06/19/2024 |
3.27.0 |
EL-6-027-27 |
UPDATE |
Annotation |
Calculate the percentage who have a partial dual code in the dual eligible code element but do not have the dual indicator in their restricted benefits code |
N/A |
06/19/2024 |
3.27.0 |
EL-6-027-27 |
UPDATE |
Specification |
STEP 1: Enrolled on the last day of DQ report monthDefine 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 missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing 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 = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Partial dualsOf the MSIS IDs which meet the criteria from STEP 2, restrict to those with a partial dual indicated in their dual eligible code :1. DUAL-ELIGIBLE-CODE = ("01" or "03" or "05" or "06")STEP 4: Not restricted benefit dualsOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. RESTRICTED-BENEFITS-CODE is not equal to "3" or "G" or is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3 |
N/A |
09/06/2023 |
3.12.0 |
EL-6-027-27 |
UPDATE |
Measure name |
% of partial duals (DUAL-ELIGIBLE-CODE = 01, 03, 05, 06) without an RBC of dual (RESTRICTED-BENEFITS-CODE not 3) |
% of partial duals (DUAL-ELIGIBLE-CODE = 01, 03, 05, 06) without an RBC of dual (RESTRICTED-BENEFITS-CODE not 3 or G) |
09/06/2023 |
3.12.0 |
EL-6-027-27 |
UPDATE |
Specification |
STEP 1: Enrolled on the last day of DQ report monthDefine 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 missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing 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 = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Partial dualsOf the MSIS IDs which meet the criteria from STEP 2, restrict to those with a partial dual indicated in their dual eligible code :1. DUAL-ELIGIBLE-CODE = ("01" or "03" or "05" or "06")STEP 4: Not restricted benefit dualsOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. RESTRICTED-BENEFITS-CODE is not equal to "3" or is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3 |
STEP 1: Enrolled on the last day of DQ report monthDefine 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 missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing 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 = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Partial dualsOf the MSIS IDs which meet the criteria from STEP 2, restrict to those with a partial dual indicated in their dual eligible code :1. DUAL-ELIGIBLE-CODE = ("01" or "03" or "05" or "06")STEP 4: Not restricted benefit dualsOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. RESTRICTED-BENEFITS-CODE is not equal to "3" or "G" or is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3 |