Chronic Condition Data Warehouse

The Chronic Condition Data Warehouse has completed a multi-year migration to the Amazon Web Services (AWS) cloud. AWS now provides Infrastructure as a Service (IaaS) components, such as networking, storage, and servers. A Software as a Service (SaaS) vendor Snowflake also provides data warehouse services.

The Chronic Condition Data Warehouse was designed for the Centers for Medicare & Medicaid Services (CMS) to support research, policy analysis, quality improvements, and demonstrations using Medicare/Medicaid patient level information linked across all claims, eligibility data, nursing home, home health assessments, and CMS beneficiary survey data. The purpose of this system is to collect and maintain a person-level view of identifiable data to establish a data repository to study chronically ill Medicare beneficiaries. This system utilizes data extraction tools to support accessing data by chronic conditions and process complex customized research data requests related to chronic illnesses.

The data collected and maintained in this system is retrieved from the following databases which are covered under their own Privacy Impact Assessments (PIAs): Medicare Drug Data Processing System, Medicare Beneficiary Database, Medicare Advantage Prescription Drug System, Medicaid Statistical Information System, Retiree Drug Subsidy Program, Common Working File, National Claims History, Enrollment Database, Carrier Medicare Claims Record, Intermediary Medicare Claims Record, Unique Physician/Provider Identification Number, Medicare Supplier Identification File, a Current Beneficiary Survey, National Plan & Provider Enumerator System, Long Term Care Minimum Data Set (MDS), Home Health Agencies (HHA) Outcome and Assessment Information Set (OASIS), and Integrated Data Repository.

The Chronic Condition Data Warehouse (CCW) system supports three scopes of work: the Chronic Condition Data Warehouse (CCW), for which the overall system is named, supports the management of the research data warehouse; the Research Data Distribution Center (RDDC) supports the dissemination of research data; and the Virtual Research Data Center (VRDC) supports the management of a secured data analytics environment. These provide a secured environment and research tools for authorized users to access data from the warehouse. Researchers may obtain access to data within the CCW or obtain extracts of data based on Data Use Agreements (DUAs) established between the researcher and CMS.

The primary purpose for the Chronic Condition Data Warehouse’s (CCW) use of the information it collects, uses, and maintains is to establish a data repository to study chronically ill Medicare beneficiaries. This system utilizes data extraction tools to support accessing data by chronic conditions and processes complex customized research data requests related to chronic illnesses. The Chronic Condition Data Warehouse regularly uses PII to retrieve records and perform analysis using:
Name, Social Security Number, Health Insurance Claim ID, Medicare Beneficiary Identifier (MBI), Date of Birth, Sex, Taxpayer ID, Provider Number, National Provider Identifier Number, Medical Notes, Military Status, Mailing Address, Medical Records Number, Race, Ethnicity, and Date of Death in order to correlate and normalize the data in the warehouse and to generate de-identified data extracts to be provided to researchers.

The Chronic Condition Data Warehouse collects and maintains user credentials to control and authenticate access to the system. The general user community consists of external researchers, CMS employees, and CMS direct contractors that will use the Chronic Condition Data Warehouse to obtain access to authorized research data. Internal support staff users responsible for maintaining the system consist of CMS employees and direct contractors. Internal support staff personnel regularly use Name, User ID, and Email Address to retrieve records of users authorized to access the Chronic Condition Data Warehouse.

• Social Security Number
• Name
• Medical Notes
• Military Status
• Taxpayer ID
• Date of Birth
• Mailing Address
• Medical Records Number
• Other - Provider Number, National Provider Identifier Number, Health Insurance Claim ID, Medicare Beneficiary Identifier (MBI), Sex, Race, Ethnicity, Date of Death, UserID, Password, Email Address, Business Address

• Employees
• Public Citizens
• Patients

09–70–0573 - Chronic Condition Warehouse

Date: 10/31/2014

09-70-0538 Individuals Authorized Access to Centers for Medicare & Medicaid Services Computer Services (IACS)

Date: 2/14/2018

• Members of the Public
• Private Sector

• Within HHS
• Other Federal Agency/Agencies
• Private Sector
• State or Local Agency/Agencies

To Center for Medicare and Medicaid Innovation (CMMI) for the purpose of testing innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits as established by section 1115A of the Social Security Act (as added by section 3021 of the Affordable Care Act).

To Policy & Data Analytics Group (PDAG) for work associated with geographic variation in spending and utilization for Medicare and Medicaid beneficiaries.

To Information Products and Analytics Group (IPAG) to update the statistics that Office of Enterprise Data and Analytics (OEDA) posts on the CMS public website about the geographic variation in the prevalence of chronic conditions among the Medicare population, as well as other public use files generated from the Geographic Variation Database (GVDB) and other sources such as nursing home assessments.

To Office of Minority Health (OMH) – OMH provides funding to external users conducting research focused on improving the effectiveness, efficiency, economy, and quality of services delivered to all Medicare beneficiaries.

To an individual or organization for a research project or in support of an evaluation project related to the prevention of disease or disability, the restoration or maintenance of health, or payment related projects, Data Use Agreement Fulfillment, Research.

To Quality Improvement Organizations (QIO) in connection with review of claims, or in connection with studies or other review activities conducted pursuant to Part B of Title XI of the Act, and in performing affirmative outreach activities to individuals for the purpose of establishing and maintaining their entitlement to Medicare benefits or health insurance plans.

Records are maintained and disposed of in accordance with the records disposition authority approved by the Archivist of the United States.

Records are destroyed or deleted after 30 years. Retention and disposal statements are pursuant to NARA Disposition Authority DAA-0440-2015-0007-0001.

Routine records will be disposed of when the agency determines they are no longer needed for administrative, legal, audit, or other operational purposes. These retention and disposal statements are pursuant to NARA General Records Schedule GRS 3.2-030, "Systems access records. Systems not requiring special accountability for access.”

Records from this system that are needed for audit purposes will be disposed of six (6) years after a user’s account becomes inactive. These retention and disposal statements are pursuant to NARA General Records Schedule GRS 3.2-031, "System access records. Systems requiring special accountability for access."

The Chronic Condition Warehouse uses National Institute of Standards and Technology (NIST), approved encryption tools for encrypting protected health information or personally identifiable information data files. A data-masking technique is applied to the beneficiary identifier for all PII, and PHI included in a data request. PII and PHI files are encrypted. The decryption password is electronically mailed only to the person identified as the recipient of the data.

CCW uses an approved courier service (with tracking receipt) to deliver all data extracts containing identifiable data. Deliveries require signature, and email confirmation of receipt is requested. The Data Center undergoes annual security assessment and authorization. Physical and environmental controls include Badging, Loading dock staging area, Operating Area Access Agreements, and Surveillance Monitoring.

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