How Eligibility Works
Could Chronic Care Management Be Right for Your Patients?
Living with two or more long-term health conditions can mean managing medications, appointments, symptoms, and care between visits. Chronic Care Management (CCM) provides eligible patients with ongoing support and care coordination to help them stay connected with their healthcare team.
Core Eligibility Criteria
- Original Medicare Part B Coverage: Your patient must have Medicare Part B (Medical Insurance) or be dually eligible (Medicare and Medicaid).
- Two or more chronic conditions: These must be long-term, at least 12 months, and not necessarily related to each other.
- Significant risk: The combination of conditions must increase the risk of death, acute decompensation, or functional decline, requiring ongoing, coordinated management.
- Provider determination: CCM eligibility depends on your patient’s individual health needs. As a healthcare provider, you will determine whether your patient may qualify based on conditions and ongoing care needs.
Diabetes
Support for eligible patients managing diabetes through ongoing communication, education, and phone follow-up between healthcare visits.
Heart Disease
Continued care support and communication can help eligible patients stay engaged with their heart-health care plan and connected with their healthcare team.
Arthritis
Ongoing support for patients managing chronic joint conditions, including help staying connected with their care plan through personalized phone follow-up.
COPD / Asthma
Personalized follow-up can help eligible patients managing chronic respiratory conditions stay connected with their care team and engaged with their ongoing care plan.
High Blood Pressure
Phone follow-up and ongoing care support can help eligible patients stay engaged with their blood-pressure management plan and communicate important information to their care team.
Every Patient Is Different
As CMS lists, arthritis, cardiovascular disease, COPD/Asthma, diabetes, and hypertension among examples of chronic conditions that may be managed through CCM.