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This variable is contained in the following files:
SAS Name
RA_OA
This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for rheumatoid arthritis/osteoarthritis as of the end of the calendar year.
ResDAC Comments
From CY 2017 to CY 2021, the MBSF: Chronic Conditions segment also has a newer (CC30) version. The algorithm used to create the Rheumatoid Arthritis / Osteoarthritis End-of-Year Indicator variable in the CC30 version includes more DX codes and a reduced claim requirement.
| Code | Code value |
|---|---|
| 0 | Beneficiary did not meet claims criteria or have sufficient fee-for-service (FFS) coverage |
| 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 |
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 rheumatoid arthritis/osteoarthritis, beneficiaries must have at least two inpatient, SNF, home health, or Part B (institutional or non-institutional) claims that are at least one day apart with a rheumatoid arthritis/osteoarthritis code in any position during the 2-year reference period.
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)