New bill aims to boost Medicare access to chronic care services

Capitol building in Washington
New legislation in the House hopes to drastically increase the number of Medicare beneficiaries that get chronic care management services, hoping to reverse low uptake rates of such care. (Photo by rarrarorro/iStock/Getty Images Plus/Getty Images)

New legislation aims to eliminate the cost-sharing requirement for Medicare beneficiaries to get chronic care management services and reimburse providers for 100% of the payment.

The legislation, reintroduced Thursday, intends to boost access among seniors to chronic care management services that include creating a care plan and medication reconciliation and adherence.

“Chronic health conditions account for 90% of our nation’s healthcare spending and this is a meaningful way to lower costs and improve health outcomes,” said Rep. Suzan DelBene, D-Washington, a lead sponsor of the Seniors’ Chronic Care Management Improvement Act. “It’s unfortunate so few seniors access this benefit and I believe dropping the cost-sharing requirements will change that.”

Currently, a Medicare beneficiary with two or more chronic conditions can get management services that were added to Medicare back in 2015.

However, over the first two years, the services were instituted only 684,000 out of 35 million eligible beneficiaries got the services, according to a fact sheet on the legislation.

“The clear majority of patients are not benefiting from coordinated care,” the fact sheet said.

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Under the current policy, providers bill Medicare monthly to get reimbursed for the chronic care management services and patients are responsible for a 20% coinsurance each month.

“For most patients, this amounts to $8 a month but for a senior on a fixed income this quickly adds up and many decide to forgo these services,” the fact sheet said.

The bipartisan legislation would eliminate the cost-sharing for patients and would reimburse the provider for 100% of the payment.

“By investing a few extra dollars a month through the Seniors’ [Chronic Care Management] Improvement Act, we ultimately save the taxpayers and seniors money while simultaneously providing a higher standard of care,” said Rep. Jeff Duncan, R-South Carolina.

The legislation has widespread approval from several provider groups such as the American Medical Association, AMGA, America’s Physician Groups, Medical Group Management Association and National Association of ACOs.

Medicare beneficiaries with multiple chronic conditions already face challenges,” said AMGA President and CEO Jerry Penso in a statement Thursday. “Removing cost-sharing requirements from [chronic care management] services will eliminate one of those challenges and help those patients to focus on their care.”