What are the Eligibility Criteria for Chronic Care Management (CCM)?

Chronic Care Management (CCM) assists patients with numerous chronic health issues. Keeping track of medications, checkups, follow-ups, and regular testing for your health concerns can be challenging and irritating. CCM is a flexible approach to staying healthy. Your team will collaborate with you to create a care plan that is unique to you. Chronic care management (CCM) services are non-face-to-face services offered to eligible individuals with numerous (two or more) chronic diseases that are projected to continue for at least 12 months or until the patient’s death.  

 Chronic Care Management is a program that instructs patients about their chronic diseases and how to manage them using a thorough treatment plan devised by their provider. This preventative program aims to promote patient health and assist practices in providing quality treatment to patients to manage their chronic diseases and increase their well-being.  

When Are Patients Eligible for CCM?   

Patients must meet specific criteria to be eligible for CCM, which include:  

  • Having two or more conditions that are anticipated to last for at least a year or until the patient passes away.  
  • Two or more states could cause death, aggravation, hypotension, or impaired functioning.  

What Types of Services Does CCM Offer?  

Assistance with patient needs from a committed care manager who will work with the patient to schedule recurring appointments and stay in touch with them frequently.   

  • Coordination of care between a provider, pharmacies, specialists, diagnostic facilities, and practices. 
  • Minimum 20 minutes of monthly phone or email support for managing chronic care.   
  • Help the community with any needs or services it may have.   
  • Ensure medications are current and appropriate for the treatment plan to assist the patient in managing them.   
  • Help from professionals in setting and achieving health goals.    

Chronic Diseases that Meet the CCM Criteria  

To be eligible for chronic care management (CCM) program patients must have a minimum of two chronic diseases. 

Cardiovascular and Blood Conditions   

 The following conditions can harm the heart or aggravate cardiovascular issues:  

  • Hypertension  
  • Heart Ischemia  
  • Heart Attack  
  • Transient Ischemia Attack or Stroke  
  • Acute Coronary Syndrome  
  • Anemia  
  • Atrioventricular Fibrillation  

Breathing Disorders  

The following respiratory and pulmonary conditions are eligible:  

  • Asthma 
  • Pulmonary illness with Chronic Obstruction   

Psychiatric and Neurological Conditions  

Conditions of the brain and mental health that are eligible for CCM include:  

  • Alzheimer’s Condition  
  • Dementia, Associated Illnesses, or Alzheimer’s Disease  
  • Depression 

Cancer Conditions  

The following cancers are eligible for CCM:  

  • Breast Cancer  
  • Lung Cancer  
  • Prostate Cancer  
  • Intestinal Cancer  
  • Cancer of the Uterus  

Bone, Joint or Muscle Conditions  

Chronic care program is available for diseases of the bones, joints, and muscles that impair a person’s quality of life, including:  

  • Osteoporosis  
  • Osteoarthritis and Rheumatoid Arthritis  
  • Hip and Pelvic Fracture  

Eye Disorders 

CCM is also available for conditions that affect a person’s vision, such as:  

  • Cataract  
  • Glaucoma   

Additional Chronic Conditions 

Other conditions that impact different body parts and are eligible for CCM include:  

  • Developing Hypothyroidism  
  • Long-term Kidney Disease  
  • A Benign Prostate Tumor  
  • Diabetes   

Additional Qualifications 

Patients can be eligible for the Medicare CCM program if they have other chronic or debilitating conditions. Other CCM conditions that might be eligible but are evaluated on a case-by-case basis include the following list:  

Mental Health and Neurological Conditions  

A wide range of disorders, such as the following, are included in neurological and mental health conditions:  

  • Behavioral Issues and the Hyperkinetic Syndrome  
  • Psychological Problems  
  • Post-traumatic Stress Disorder (PTSD)  
  • Anxiety Problems 
  • Depressive Illnesses  
  • Spectrum Diseases in Autism  
  • The Psychotic Diseases Schizophrenia and Others  
  • A Bipolar Condition  
  • Traumatic Brain Injury and Brain damage-related Nonpsychotic Mental Disorders  
  • Constant Headaches and Migraine  
  • Spinal Palsy  
  • Epilepsy   

Drug Use Disorders  

A substance use disorder can emerge in someone who relies on a drug. Those who might be eligible for CCM include:  

  • Alcohol Abuse Disorders  
  • Addiction to Opioids  
  • Nicotine Use  
  • Other Drugs Use Disorders   

Immune Conditions  

The CCM program may apply to conditions that impair a person’s immune system and capacity to recover from harm or sickness. These conditions include:  

  • HIV/AIDS  
  • Hepatitis Virus  
  • Transverse Myelitis and Multiple Sclerosis  

Blood Disorders  

The following blood disorders and blood cancers may be eligible for the CCM program:  

  • Acute myeloid leukemia  
  • Lymphomas and leukemias  
  • Vascular disease of the periphery   

Conditions Affecting the Spine, Joints, Bones, or Muscles  

This category includes any condition that affects the neurological system, bones, muscles, or joints, such as:  

  • Injury to the Spinal Cord  
  • Congenital Abnormalities of the Neurological System, such as Spina Bifida  
  • Dystrophic Muscle  
  • Pressure Ulcers that are Ongoing  
  • Chronic Pain, Fibromyalgia, and Exhaustion  

Conditions Related to Organs  

These disorders, which may affect one or more organs, include:  

  • Cirrhosis and Liver Diseases  
  • Metabolic Developmental Diseases like Cystic Fibrosis  

Additional Disabling Problems  

Other illnesses may be eligible for CCM if they are debilitating and impact vital functions. These circumstances include:  

  • Developmental Delays and other Learning Disabilities  
  • Conditions that are related to Intellectual Impairments  
  • Blindness and Poor Vision  
  • Hearing Loss and Deafness  
  • Limitations to Mobility  
  • Obesity   

Bottom Line  

This guide demonstrated the eligibility criteria of Chronic Care Management and explained all the illnesses and chronic conditions eligible for CCM. This guide concludes that CCM is an approach to managing a disease that integrates care and involves patient education, screenings, checkups, monitoring, and treatment coordination. 

If you want to integrate Medicare chronic care management into your practice, CareCloud is your best bet. We are a health IT service firm helping medical practices improve their revenue with chronic care management programs. 

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