Discussion of Undefined Patient Qualifying Elements Under 2015 Final Rule

CMS provides broad criteria for qualifying CCM eligible patients.

Does CMS define which Chronic Conditions meet the criteria for CCM?

NO! The Final Rule is broad on the subject and allows physicians to make medical decisions concerning their patients. Physicians must consider the multiple chronic conditions of their patients who suffer disease states of the most severe acuity and those which place these patients at serious risk as defined above. In its 2014 rule commentary, CMS stated that its intent was not to be prescriptive in defining chronic conditions. Its research was based on chronic conditions as defined in a Medicare list of chronic conditions but, “We note that we did not propose to limit the eligible chronic conditions to those contained in our Medicare data analysis.”………….

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