EL-6-032-35

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

EL-6-032-35

Data Quality Measure

Last updated

Key Information

Measure Name	% of MSIS IDs with restricted benefits code designating MFP participation (RESTRICTED-BENEFITS-CODE = D) that are not found on MFP-INFORMATION-ELG00010 for the same month
File Type	ELG
Measure ID	EL-6-032-35
Measure Type	Non-Claims Percentage
Content area	ELG

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	Medium
Focus Area	N/A
Category	Program participation

Claim Information

Claim Type	N/A
Adjustment Type	N/A
Crossover Type	N/A

Thresholds

Minimum	0
Maximum	0.3
TA Minimun	0
TA Maximum	0.3
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 • RESTRICTED-BENEFITS-CODE • MSIS-IDENTIFICATION-NUM
DD Data Element Number	ELG082 • ELG097 • ELG149

Annotation

Calculate the percentage of eligibles with a restricted benefits code designating Money Follows the Person participation that are not included in the ELG00010 segment for the same month

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: Money Follows the Person participation

Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:

1. RESTRICTED-BENEFITS-CODE = “D”

STEP 4: MFP enrollment on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 3, join to segment MFP-INFORMATION-ELG00010 by keeping records that satisfy the following criteria:

1. MFP-ENROLLMENT-EFF-DATE <= last day of the DQ report month AND is not missing

2. MFP-ENROLLMENT-END-DATE >= last day of the DQ report month OR missing

STEP 5: No MFP Enrollment

Subtract the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 4

STEP 6: Calculate percentage

Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3

Published Date	Data Guide Version	DQM	Action	Field	Before	After
03/10/2023	3.4.0	EL-6-032-35	UPDATE	Priority	High	Medium
01/27/2023	3.2.0	EL-6-032-35	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: Money Follows the Person participationOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. RESTRICTED-BENEFITS-CODE = “D”STEP 4: MFP enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment MFP-INFORMATION-ELG00010 by keeping records that satisfy the following criteria:1. MFP-ENROLLMENT-EFF-DATE <= last day of the DQ report month AND is not missing2. MFP-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingSTEP 5: No MFP EnrollmentSubtract the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 4STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 54 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: Money Follows the Person participationOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. RESTRICTED-BENEFITS-CODE = “D”STEP 4: MFP enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment MFP-INFORMATION-ELG00010 by keeping records that satisfy the following criteria:1. MFP-ENROLLMENT-EFF-DATE <= last day of the DQ report month AND is not missing2. MFP-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingSTEP 5: No MFP EnrollmentSubtract the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 4STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3