Chronic Conditions

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Chronic diseases are defined broadly as conditions that require ongoing medical attention or limit activities of daily living or both. Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States. They are also leading drivers of the nation’s $4.1 trillion in annual healthcare costs.

CMS developed the 27 CCW Chronic Condition variables from algorithms validated from the research literature and criteria used by other federal sources. In 2020, CMS contracted an expert panel to refine and enhance these algorithms, resulting in the 30 CCW Chronic Condition algorithms.

• Acute Myocardial Infarction
• Alzheimer's Disease
• Anemia
• Asthma
• Atrial Fibrillation and Flutter
• Benign Prostatic Hyperplasia
• Cancer, Breast
• Cancer, Colorectal
• Cancer, Endometrial
• Cancer, Lung
• Cancer, Prostate
• Cancer, Urologic (Kidney, Renal Pelvis, and Ureter) 
• Cataract
• Chronic Kidney Disease
• Chronic Obstructive Pulmonary Disease
• Depression, Bipolar, or Other Depressive Mood Disorders
• Diabetes
• Glaucoma
• Heart Failure and Non-Ischemic Heart Disease
• Hip/Pelvic Fracture
• Hyperlipidemia
• Hypertension
• Hypothyroidism
• Ischemic Heart Disease
• Non-Alzheimer's Dementia
• Osteoporosis With or Without Pathological Fracture
• Parkinson's Disease and Secondary Parkinsonism 
• Pneumonia, All-cause 
• Rheumatoid Arthritis/Osteoarthritis
• Stroke/Transient Ischemic Attack

There are 40 other chronic health, mental health, substance abuse, and potentially disabling condition categories available for file years 2000 forward. These conditions enhance research of the Medicare-Medicaid dual enrolled population; however, they are available for all non-dually enrolled Medicare and Medicaid beneficiaries as well.

• ADHD, Conduct Disorders, and Hyperkinetic Syndrome
• Alcohol Use Disorders
• Anxiety Disorders
• Autism Spectrum Disorders
• Bipolar Disorder
• Cerebral Palsy
• Cystic Fibrosis and Other Metabolic Developmental Disorders
• Depressive Disorders
• Drug Use Disorders
• Epilepsy
• Fibromyalgia, Chronic Pain and Fatigue
• Human Immunodeficiency Virus and/or Acquired Immunodeficiency Syndrome (HIV/AIDS)*
• Intellectual Disabilities and Related Conditions
• Learning Disabilities
• Leukemias and Lymphomas
• Liver Disease, Cirrhosis and Other Liver Conditions (except Viral Hepatitis)
• Migraine and Other Chronic Headache
• Mobility Impairments
• Multiple Sclerosis and Transverse Myelitis
• Muscular Dystrophy
• Obesity
• Opioid Use Disorder (OUD) 1: Overarching Opioid Use Disorder
• OUD 2: Diagnosis- and Procedure-code basis for OUD
• OUD 3: Opioid-related Hospitalizations/ED Visits
• OUD 4: Utilization of Medication-Assisted Therapy (MAT)
• Other Developmental Delays
• Peripheral Vascular Disease (PVD)
• Personality Disorders
• Post-Traumatic Stress Disorder (PTSD)
• Pressure Ulcers and Chronic Ulcers
• Schizophrenia
• Schizophrenia and Other Psychotic Disorders
• Sensory - Blindness and Visual Impairment
• Sensory - Deafness and Hearing Impairment
• Sickle Cell Disease
• Spina Bifida and Other Congenital Anomalies of the Nervous System
• Spinal Cord Injury
• Tobacco Use Disorders
• Traumatic Brain Injury and Nonpsychotic Mental Disorders due to Brain Damage
• Viral Hepatitis **

** Includes A-E subtypes.