What Conditions Qualify For Chronic Care Management

What Conditions Qualify For Chronic Care Management

Chronic Health Management (CHM) aids individuals dealing with multiple chronic health conditions. Navigating medications, appointments, follow-ups, and routine health tests can pose challenges and frustrations. CHM offers a flexible strategy for maintaining well-being. Your team will collaborate closely with you to craft a personalized care plan tailored to your needs. Chronic health management (CHM) services encompass remote services provided to eligible individuals grappling with multiple (two or more) chronic ailments expected to persist for at least 12 months or until the patient’s demise.

The Chronic Health Management program educates patients on their chronic conditions and effective management through a comprehensive treatment plan devised by their healthcare provider. This proactive program seeks to boost patient well-being and aid practices in delivering top-notch care to patients to effectively manage their chronic illnesses and enhance their overall quality of life.

Who is Eligible for Chronic Care Management 

Patients need to satisfy particular requirements to qualify for CCM, which encompass the following:

  • Possessing two or more conditions that are projected to endure for a minimum of a year or until the patient’s demise.
  • Two or more states could potentially result in a fatality, exacerbation, low blood pressure, or hindered functioning.

Conditions Qualify For Chronic Care Management

In order to meet the eligibility criteria for Medicare’s Chronic Care Management (CCM) program, individuals must possess a minimum of two persistent ailments. We have outlined a selection of notable qualifying disorders as outlined by the Centers for Medicare & Medicaid Services (CMS) below, though the list is not exhaustive. Patients who do not find their condition listed are encouraged to get in touch with their healthcare provider to determine if they meet the requirements.

Cardiovascular & Blood Ailments

The subsequent ailments can damage the heart or exacerbate cardiovascular problems:

  • High Blood Pressure
  • Cardiac Ischemia
  • Myocardial Infarction
  • Transient Ischemic Attack or Cerebrovascular Accident
  • Acute Coronary Syndrome
  • Low Red Blood Cell Count
  • Atrioventricular Flutter

Respiratory Disorders

The following respiratory and lung conditions are eligible:

  • Bronchial Asthma
  • Chronic Obstructive Pulmonary Disease

Psychiatric And Neurologic Ailments

Conditions of the brain and mental well-being that meet the criteria for CCM comprise:

  • Alzheimer’s Disorder
  • Dementia, Associated Pathologies, or Alzheimer’s Condition
  • Mood Disorder

Cancer Ailments

The ensuing malignancies are eligible for CCM:

  • Breast Carcinoma
  • Pulmonary Carcinoma
  • Prostatic Carcinoma
  • Colonic Carcinoma
  • Uterine Carcinoma

Skeletal, Articular, Or Muscular Conditions

A persistent care program is available for maladies of the skeletal system, articulations, and musculature that impede an individual’s quality of life, including:

  • Brittle Bone Disease
  • Degenerative Joint Disease and Autoimmune Joint Inflammation
  • Fracture of the Hip and Pelvis

Ocular Disorders

CCM is also accessible for disorders impacting an individual’s sight, such as:

  • Clouding of the Eye Lens
  • Increased Intraocular Pressure

Additional Chronic Ailments

Other conditions that affect diverse bodily regions and qualify for CCM encompass:

  • Onset of Hypothyroidism
  • Prolonged Renal Dysfunction
  • A Noncancerous Prostate Growth
  • Type 2 Diabetes

Additional Eligibility Criteria

Patients may qualify for the Medicare CCM program if they have other chronic or incapacitating conditions. Other CCM-qualifying conditions that may be eligible but are assessed on a case-by-case basis include the subsequent list:

Mental Health And Neurological Ailments

An extensive array of disorders, like the following, fall under neurological and mental health conditions:

  • Behavioral Challenges and Hyperkinetic Disorder
  • Psychological Ailments
  • Post-traumatic Stress Syndrome (PTSD)
  • Anxious Disorders
  • Clinical Depression
  • Spectrum Disorders in Autism
  • Schizophrenia and Other Psychotic Ailments
  • A Condition of Bipolarity
  • Traumatic Brain Injury and Nonpsychotic Mental Disorders due to Brain Injury
  • Frequent Headaches and Migraine
  • Spinal Paralysis
  • Epilepsy

Substance Use Disorders

A substance dependence disorder can arise in someone dependent on a substance. Those who could be eligible for CCM encompass:

  • Alcohol Dependency Disorders
  • Opioid Addiction
  • Tobacco Use
  • Other Substance Dependence Disorders

Immune Ailments

The CCM initiative might pertain to conditions impairing an individual’s immune system and their ability to recuperate from harm or illness. These conditions encompass:

  • Infection with Hepatitis Virus
  • Transverse Myelitis and Multiple Sclerosis

Blood-Related Ailments

The ensuing blood-related disorders and blood-based malignancies might meet the requirements for the CCM program:

  • Acute Myelogenous Leukemia
  • Lymphomas and Leukemias
  • Peripheral Vascular Disease

Conditions Impacting The Spinal Column, Joints, Bones, Or Muscles

This category involves any condition influencing the neurological system, bones, muscles, or joints, like:

  • Spinal Cord Trauma
  • Congenital Aberrations of the Neurological System, such as Spina Bifida
  • Muscular Dystrophy
  • Persistent Bed Sores
  • Pervasive Discomfort, Fibromyalgia, and Fatigue

Ailments Connected To Bodily Organs

These disorders, which could impact one or more organs, encompass:

  • Cirrhosis and Hepatic Ailments
  • Metabolic Developmental Disorders like Cystic Fibrosis

Additional Debilitating Issues

Other illnesses could qualify for CCM if they are incapacitating and affect essential functions. These circumstances include:

  • Developmental Delays and other Learning Impairments
  • Conditions linked to Intellectual Disabilities
  • Sightlessness and Impaired Eyesight
  • Hearing Impairment and Deafness
  • Mobility Limitations
  • Obesity

Deliver Optimal Patient Care Through a Fully Managed CCM Program

360Healthtek empowers patients to access appropriate care for their persistent conditions. We support healthcare facilities and medical centers in identifying eligible patients, securing their consent, enhancing their well-being through consistent care, and generating added revenue in the process.

Our Comprehensive Chronic Care Management Program enables medical practice personnel to allocate more time to patient interactions and streamline their care. We assist all categories of healthcare settings, including Rural Health Clinics (RHC) or Federally Qualified Health Clinics (FQHC), with our Chronic Care Management Services. We back your healthcare providers by managing outreach, enrollment, follow-ups, and minor administrative tasks. Our comprehensive patient services encompass:

  • Round-the-clock care availability 
  • Resources for addressing Social Determinants of Health
  • Support for prescription refills
  • Assistance with appointment scheduling
  • Aid with medical imaging, laboratory work, and test result coordination

These represent only a selection of the numerous patient-centered solutions we offer to aid clinics in delivering sufficient patient care. We can help identify care gaps and provide data to assist you in surpassing your quality care benchmarks.

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