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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 Conditions 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 previous (CC27) version. The algorithm used to create the Rheumatoid Arthritis / Osteoarthritis End-of-Year Indicator variable in the CC27 version includes fewer DX codes and an increased 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 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 rheumatoid arthritis/osteoarthritis, 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 rheumatoid arthritis/osteoarthritis code in any position during the two-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)