Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation or functional decline are eligible for CCM services.
Not all patients qualify for CCM services. Those who do must meet the following three criteria:
- Patient must have two or more chronic conditions.
- Conditions are expected to last at least 12 months or until death of the patient.
- Conditions place the patient at significant risk of death, acute exacerbation (i.e. worsening of condition), decompensation (i.e. organ failure), or functional decline.
While CMS does not have a set list of chronic conditions, they do provide a brief summary of conditions that may apply (see below). They also have a databank of chronic conditions that may be a helpful resource for physicians, although this is not an all-inclusive list by any means.
Otherwise, the decision of what classifies as chronic is left up to the treating physician, along with the responsibility of providing detailed supporting chart documentation and an appropriate care plan.