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 that are projected to continue for at least 12 months or until the patient’s death.
CARDIOVASCULAR AND BLOOD CONDITIONS
The following cardiovascular and blood conditions can harm the heart or exacerbate cardiovascular issues:
- Acute Coronary Syndrome
- Anemia
- Atrioventricular Fibrillation
- Congestive Heart Failure
- Coronary Artery Disease
- Heart Attack
- Hypertension
- Transient Ischemia Attack
- Cerebrovascular Accident
- Hyperlipidemia
BREATHING DISORDERS
The following respiratory and pulmonary conditions are eligible:
- Asthma
- Chronic Obstructive Pulmonary Disease
- Obstructive Sleep Apnea
NEUROLOGICAL CONDITIONS
Conditions of the brain that are eligible for CCM include:
- Alzheimer’s Disease
- Dementia
- Epilepsy
- Parkinson’s Disease
- Constant Headaches and Migraine
- Cerebral Palsy
- Transverse Myelitis
- Multiple Sclerosis
CANCER CONDITIONS
The following cancers are eligible for CCM:
- Breast Cancer
- Lung Cancer
- Intestinal Cancer
- Prostate Cancer
- Uterine Cancer
SPINE, BONE, JOINT OR MUSCLE CONDITIONS
Chronic care program is available for diseases of the neurological system, bones, joints, and muscles that impair a person’s quality of life, including:
- Osteoporosis
- Osteoarthritis and Rheumatoid Arthritis
- Hip and Pelvic Fracture
- 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
- Gout
EYE DISORDERS
CCM is also available for conditions that affect a person’s vision, such as:
- Cataract
- Glaucoma
- Total Vision Loss
ENDOCRINE DISORDERS
Endocrine disorders that are eligible for CCM include:
- Diabetes
- Vitamin D deficiency
- Hyperthyroidism
- Hypothyroidism
- Grave’s Disease
MENTAL HEALTH CONDITIONS
A wide range of disorders, such as the following, are included in covered mental health conditions:
- Behavioral Issues and the Hyperkinetic Syndrome
- Post-traumatic Stress Disorder (PTSD)
- Anxiety
- 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
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
- Lupus
GASTROINTESTINAL DISORDERS
The following gastrointestinal diseases may be eligible for the CCM program:
- GERD
- Inflammatory Bowel Disease (IBD)
- Irritable Bowel Syndrome (IBS)
- Ulcerative Colitis
- Crohn’s Disease
- Chronic Pancreatitis
BLOOD DISORDERS
- Acute myeloid leukemia
- Lymphomas and leukemias
- Peripheral Vascular Disease
- Coagulopathies – hemophilia, thrombocytopenia (ITP) and von Willebrand disease.
CONDITIONS RELATED TO ORGANS
These disorders, which may affect one or more organs, include:
- Cirrhosis
- Chronic Hepatitis C
- Chronic Kidney Disease
- End Stage Kidney Disease
- Cystic Fibrosis
- Benign Prostatic Hyperplasia (BPH)
- Non-Alcoholic Fatty Liver Disease
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
- Limitations to Mobility
- Obesity
source: https://www2.ccwdata.org/web/guest/condition-categories