CMS Pub. 100-16, ch. mc86c16b, § 20.1.2

Section 1859(b)(6)(B)(iii) of the Act and 42 CFR 422.2 define special needs individuals with

severe or disabling chronic conditions as special needs individuals “who have one or more co-morbid and medically complex chronic conditions that are substantially disabling or life

threatening; have a high risk of hospitalization or other significant adverse health outcomes; and

require specialized delivery systems across domains of care.” CMS solicited public comments

on chronic conditions meeting the clarified definition and convened the SNP Chronic Condition

Panel in the fall of 2008. Panelists included six clinical experts on chronic condition

management from three federal agencies—the Agency for Healthcare Research and Quality

(AHRQ), the Centers for Disease Control and Prevention (CDC), and CMS. After discussing

public comments on a proposed list of SNP-specific chronic conditions, the panelists

recommended, and CMS subsequently approved, the following 15 SNP-specific chronic

conditions:

1. Chronic alcohol and other drug dependence;

2. Autoimmune disorders limited to:

• Polyarteritis nodosa,

• Polymyalgia rheumatica,

• Polymyositis,

• Rheumatoid arthritis, and

• Systemic lupus erythematosus;

3. Cancer, excluding pre-cancer conditions or in-situ status;

4. Cardiovascular disorders limited to:

• Cardiac arrhythmias,

• Coronary artery disease,

• Peripheral vascular disease, and

• Chronic venous thromboembolic disorder;

5. Chronic heart failure;

6. Dementia;

7. Diabetes mellitus;

8. End-stage liver disease;

9. End-stage renal disease (ESRD) requiring dialysis;

10. Severe hematologic disorders limited to:

• Aplastic anemia,

• Hemophilia,

• Immune thrombocytopenic purpura,

• Myelodysplatic syndrome,

• Sickle-cell disease (excluding sickle-cell trait), and

• Chronic venous thromboembolic disorder;

11. HIV/AIDS;

12. Chronic lung disorders limited to:

• Asthma,

• Chronic bronchitis,

• Emphysema,

• Pulmonary fibrosis, and

• Pulmonary hypertension;

13. Chronic and disabling mental health conditions limited to:

• Bipolar disorders,

• Major depressive disorders,

• Paranoid disorder,

• Schizophrenia, and

• Schizoaffective disorder;

14. Neurologic disorders limited to:

• Amyotrophic lateral sclerosis (ALS),

• Epilepsy,

• Extensive paralysis (i.e., hemiplegia, quadriplegia, paraplegia, monoplegia),

• Huntington’s disease,

• Multiple sclerosis,

• Parkinson’s disease,

• Polyneuropathy,

• Spinal stenosis, and

• Stroke-related neurologic deficit; and

15. Stroke.

The list of SNP-specific chronic conditions is not intended for purposes other than clarifying

eligibility for the C-SNP CCP benefit package. CMS may periodically re-evaluate the fifteen

chronic conditions as it gathers evidence on the effectiveness of care coordination through the

SNP product, and as health care research demonstrates advancements in chronic condition

management.