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11.15.2018 SES Guidelines To calculate a member’s SES stratification, the instructions say to evaluate whether the member’s LIS values (item 35) are the same or different in the last 3 months of continuous enrollment (CE). How do you determine if a value is the same or different?

A value is different if it is either < or = 0 OR > 0. For the last 3 months of the CE period:

  • Count the member as receiving an LIS payment if 2 of the last 3 months are >0, even if the values are different.
           Example:
           October       LIS = 35
           November   LIS = 40
           December   LIS = -35
  • Count the member as NOT receiving an LIS payment if 2 of the last 3 months are < or = 0, even if the values are different.
          Example:
          October       LIS = 0
          November   LIS = -35
          December   LIS = 35

 

ALL 2019