This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for diabetes as of the end of the calendar year.
The CCW’s chronic condition flags require beneficiaries to satisfy both claims criteria (a minimum number/type of claims that have the proper diagnosis codes and occurred within a specified time period) and coverage criteria (FFS Part A and Part B coverage during the entire specified time period).
For diabetes, beneficiaries must have at least one inpatient, SNF, or home health claim, or two Part B (institutional or non-institutional) claims with a diabetes code in any position during the 2-year reference period. When 2 claims are required, they must occur at least one day apart.
The CCW’s criteria were developed after reviewing validated algorithms from the research literature and criteria used by other federal data sources. You can find more detailed information on the criteria on the CCW website: https://www.ccwdata.org/web/guest/condition-categories
Source: CCW (derived)
From CY 2017 to CY 2021, the MBSF: Chronic Conditions segment also has a newer (CC30) version. The algorithm used to create the Diabetes End-of-Year Indicator variable is the same for both versions.
|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|