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Proposed legislation aimed at comorbidity among Medicare beneficiaries

April 4, 2016
by Robert Gatty
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Robert Gatty

A "policy options document" developed by the U.S. Senate Finance Committee's Chronic Care Working Group could form the basis for new legislation with a significant impact on the long-term care industry.

Issued last December following a series of hearings and stakeholder meetings, the document suggests a series of options for the committee to consider with the goal of improving how Medicare treats beneficiaries with multiple, complex chronic illnesses. The Working Group says any policy under consideration should meet these key objectives:

  • Increase care coordination among individual providers across care settings who are treating individuals living with chronic diseases;
  • Streamline Medicare’s current payment systems to incentivize the appropriate level of care; and
  • Facilitate delivery of high-quality care, improve care transitions, produce stronger patient outcomes, increase program efficiency and contribute to an overall effort to reduce the growth in Medicare spending.

Should the committee decide to move forward with its recommendations and develop a final document, revised after submitted comments, that action is expected to wait until the new Congress convenes in January 2017 when lawmakers can return their focus to making improvements many consider necessary while also reducing overall healthcare expenditures.

Policy Options

Some of the policy options in the document include:

  • Expanding the Independence at Home Model of Care (IAH) demonstration into a permanent, nationwide program.
  • Expanding access to home hemodialysis therapy by including free-standing renal dialysis facilities in its qualified originating site definition.
  • Requiring Medicare Advantage (MA) plans to offer the hospice benefit provided under traditional Medicare.
  • Allowing end stage renal disease beneficiaries to choose a MA plan no matter when their condition began.
  • Providing continued access to MA special needs plans (SNP) for vulnerable populations through a long-term extension or permanent authorization of SNPs as established under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
  • Improving care management services for individuals with multiple chronic conditions by establishing a new high-severity chronic care management code under the physician fee schedule.
  • Developing policies to improve integration of care for individuals with a chronic disease combined with a behavioral health disorder.
  • Providing MA plans the flexibility to establish a benefit structure that varies based on chronic conditions of individual enrollees.
  • Expanding supplemental benefits for chronically ill MA enrollees.
  • Using telehealth to increase convenience for MA enrollees and for individuals who have suffered a stroke.
  • Providing Accountable Care Organizations (ACO) the ability to expand use of telehealth.
  • Clarifying that ACOs participating in the Medicare Shared Savings Program (MSSP) may furnish a social or transportation service for which payment is not made under fee-for-service Medicare.
  • Ensuring accurate payment for chronically ill individuals.
  • Providing flexibility for beneficiaries to be part of an ACO.
  • Developing quality measures for chronic conditions.
  • Encouraging beneficiary use of chronic care management services.
  • Establishing a one-time visit code post initial diagnosis of Alzheimer’s disease, dementia or other serious or life-threatening illnesses.
  • Eliminating barriers to care coordination under ACOs.
  • Expanding access to prediabetes education.
  • Expanding access to digital coaching to help beneficiaries learn more about their health conditions and in the self-management of their own health.
  • Icreasing transparency at the Center for Medicare & Medicaid Innovation.
  • Conducting a study of medication synchronization.
  • Conducting a study on obesity drugs.

AHCA/NCAL Comments

The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) responded to the committee’s request for comments on policy that meets the key objectives AHCA/NCAL says it is essential to distinguish between very ill individuals who account for a high percentage of Medicare spending from the much larger population of those with one or two chronic diseases—and that any new policies designed for the chronically ill "must go beyond addressing not only a single condition but rather a web of interrelated challenges." Medicare spends more than $300 billion annually to care for such individuals, three times higher than the average beneficiary.

The association also expressed concern about "the number and pace of changes" being proposed.

"The Working Group should carefully consider unintended consequences of the proposed policy options," AHCA/NCAL says. "Such unexpected impacts could interact with existing demonstrations or payment systems that already are moving from traditional fee-for-service to other payment methods and negatively affect patient access." 

Clifton Porter II, senior vice president of government relations at AHCA/NCAL, says to Long-Term Living a majority of individuals cared for by the organization’s members have chronic  conditions, and that number is increasing. "We urge a continued careful, thoughtful and deliberative process to ensure that final policy recommendations benefit not only those individuals with chronic medical conditions, but also the providers that support and care for them," Porter said.

Read the document here.