Who is eligible?
This program is covered by Medicare and could be covered-in-full if you have a secondary insurance. Full coverage depends on your secondary insurance carrier or Medicare Replacement Plan Coverage. Although Medicare developed this program, you do not need to be a Medicare beneficiary to take advantage of these valuable services. Most commercial and Medicare Advantage plans also cover this benefit. Like all other healthcare services, Care Management is subject to your annual insurance deductible, coinsurance, and copay. Depending on your specific benefits there may be a minimal fee associated with the program.
You can find additional information by searching ‘CCM’ at www.cms.gov
Here are the benefits of the Care Management program:
- You will have a dedicated Care Coordinator who will collaborate with you and your provider to create a personalized and comprehensive care plan.
- Your Care Coordinator will focus on improving care coordination to enhance outcomes and reduce unnecessary ER visits, hospital stays, or readmissions after discharge.
- Care Coordinators will assess your current condition, address treatment plan queries, review medications, and help with pharmacy coordination.
- They will schedule appointments, facilitate communication with your Primary Care Provider (PCP) and specialists, work towards quality-of-life goals, and connect you with any required support services.
- Specialist consultations will be thoroughly reviewed by your care team, and your Care Coordinator will arrange additional consultations, diagnostic work-ups, or follow-up appointments as recommended by your provider.
What are chronic and high-risk conditions?
Chronic and high-risk conditions are health conditions that persist for over a year and require ongoing medical care, according to the Centers for Disease Control and Prevention. These conditions can also limit a patient’s ability to perform essential daily activities like eating, bathing, dressing, toileting, transferring, and maintaining continence.
The Center for Medicare and Medicaid Services has identified the following list of chronic or high-risk conditions. Additionally, Urologic chronic conditions such as Benign Prostatic Hyperplasia (BPH), overactive bladder (OAB), recurrent urinary tract infection, bladder cancer, renal cancer, prostate cancer, ureter cancer, and renal pelvis cancer fall under this category.
CMS list of chronic and high-risk conditions (including but not limited to):
