This variable indicates whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for autism spectrum disorders as of the end of the calendar year.
The CCW’s other chronic or potentially disabling condition variables require enrollees to satisfy both claims criteria (a minimum number/type of Medicare claims that have the proper diagnosis codes and occurred within a specified time period) and coverage criteria (Medicare FFS Part A and Part B coverage during the entire specified time period).
For autism spectrum disorders, beneficiaries must have at least one Medicare inpatient claim or two other non-drug claims of any service type with a related code in any position during the 2-year reference period. When 2 claims are required, they must occur at least one day apart.
You can find more detailed information on the criteria on the CCW website: https://www.ccwdata.org/web/guest/condition-categories
Source: CCW (derived)
|0||Beneficiary did not meet claims criteria or have sufficient fee-for-service (FFS)
|1||Beneficiary met claims criteria but did not have sufficient FFS coverage|
|2||Beneficiary did not meet claims criteria but had sufficient FFS coverage|
|3||Beneficiary met claims criteria and had sufficient FFS coverage|