Chronic Care Management (CCM) is a program designed by Medicaid for patients living with chronic illnesses. Through this program, they can work with their physician to develop an effective treatment plan that improves the outcomes. CCM aims to improve patients’ health with chronic issues while helping providers offer quality treatment that helps with disease management.
But for a patient to there are CCM qualifying conditions, they must meet the qualifying conditions outlined by the Centers for Medicare and Medicaid Services (CMS). Today, we list some of the CCM qualifying conditions. Please note that this list is not extensive. So, if the patient doesn’t see their condition, you can encourage them to check with their provider.
Here are the chronic qualifying conditions.
Neurological Issues and Mental Health Problems
CCM services cover the brain and mental health conditions like:
- Depression
- Alzheimer’s and Alzheimer’s related disease or dementia
- Migraine and chronic headache
- Post-traumatic stress disorder
- Anxiety
- Autism spectrum disorders
- Bipolar disorders
- Traumatic brain injury disorders
- Cerebral palsy
- Personality disorders
- Epilepsy
- Schizophrenia and other psychotic disorders
Respiratory Conditions
These affect the lungs and the entire respiratory system. They include:
- Asthma
- Chronic Obstructive Pulmonary Disease
Cancer
Various cancers are categorized under CCM-qualifying conditions. These include:
- Breast cancer
- Prostate cancer
- Lung cancer
- Colorectal cancer
Related article: Dispelling Common Myths About CCM
Conditions Affecting the Eyes
These impact a person’s vision and include:
- Cataract
- Glaucoma
Cardiovascular Diseases and Blood Conditions
These are illnesses damaging the heart or contributing to heart problems. They include:
- Heart failure
- Stroke
- Anemia
- Hypertension
- Acute Myocardial Infarction
- Ischemic heart disease
- Hyperlipidemia
- Atrial Fibrillation
Bone, Joint or Muscle Conditions
Such illnesses can affect a person’s quality of life. Those qualifying for CCM include:
- Hip/pelvic fracture
- Rheumatoid arthritis/osteoarthritis
- Osteoporosis
- Spinal cord injury
- Pressure and chronic ulcers
- Fibromyalgia, fatigue, and chronic pain
- Muscular dystrophy
- Spina bifida and other abnormalities of the nervous system
Organ Related Problems
These affect one or several organs ad include:
- Cystic fibrosis and other disorders affecting metabolic developmental
- Liver disease, Liver cirrhosis, and other liver issues
Blood Conditions
chronic care management services are also offered for blood diseases and blood cancers. Those qualifying for CCM include:
- Sickle cell disease
- Peripheral vascular disease
- Leukemia and lymphomas
Auto-Immune Disorders
These are diseases that damage one’s immune system. As a result, they find it hard to recover from injuries or illness and meet CCM eligibility. They include:
- Viral hepatitis
- Multiple sclerosis and traverse myelitis
- HIV/AIDs
Substance Use Disorders
These occur when a person becomes dependent on a substance. Chronic qualifying conditions in this category include:
- Tobacco use
- Opioid use
- Alcohol use and other drug use disorders
When is Someone Eligible for CCM?
Medicare requires patients to meet certain requirements before they are considered for CCM. For one, the patient must have two or more chronic conditions that are expected to last for a minimum of twelve months or until the person dies. Also, they must have two or more conditions that increase their risk of functional decline, decompensation, exacerbation, and death.
Additionally, providers must create a comprehensive care plan that is well-established, monitored, and implemented. It should be available to the patient. This criterion eliminated ethnic and racial disparities in the medical world.
Once a patient qualifies and enrolls for CCM, they should receive at least 20 minutes of care every month from a clinical staff under the supervision of a physician or a professional healthcare provider. Most times, these minutes are not face-to-face. But if there is a need for the patient to visit the in-office concerning CCM services, they will be seen face-to-face with their healthcare provider. Additionally, the patient is entitled to 24/7 access to their care team if they have an urgent medical need.
Why is CCM Important?
Previously, when a person felt ill, they had to book an appointment with the doctor and visit them in person for assistance. However, many realized that this system deprived patients of the freedom to take charge of their health education.
Picture this; a patient has Asthma and obesity. And they have to visit a hospital annually for checkups and want to prevent other chronic conditions like cancers. But after a year hasn’t improved, and it reaches a point where the care team feels the patient isn’t listening or following their recommendations for healthy living. However, because you don’t have enough time to follow up, the patients get lost with other patients that visit annually.
A CCM program offers a different approach to treatment. If the patient enrolls in a clinic, they will get a monthly call to discuss their health and the possibilities of additional chronic conditions. Also, the providers can monitor them closely to ensure they are at par with their recommendations and treatment plans. This leads to better health outcomes.
Final Thoughts
Well, there are some CCM qualifying conditions. But we emphasize that this isn’t the whole list. Therefore, the patient should consult with their provider if their condition is missing from the above list.
