This variable indicates whether a beneficiary met the Chronic Conditions Warehouse (CCW) criteria for all-cause pneumonia as of the end of the calendar year.
The CCW’s chronic condition indicator variables 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 all-cause pneumonia, beneficiaries must have at least one inpatient, skilled nursing facility (SNF), or home health claim, or two Part B (institutional or non-institutional) claims that are at least one day apart, with a pneumonia code in any position during the one-year reference period.
You can find more detailed information on the algorithm criteria on the CCW website: https://www.ccwdata.org/web/guest/condition-categories-chronic
Source: CCW (derived)
From CY 2017 to CY 2021, the MBSF: Chronic Conditions segment also has a previous (CC27) version. This variable is not available in the CC27 version.
|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|