On April 6, 2017, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 was reintroduced by the Senate Finance Committee’s Chronic Care Working Group. The bill was introduced by Senate Finance Committee Chairman Orrin Hatch and Ranking Member Ron Wyden, along with Johnny Isakson and Mark Warner, the co-chairs of the Committee’s Chronic Care Working Group. The bill is largely unchanged from the previous version, which was introduced in December 2016.
The CHRONIC Care Act is intended to improve the Medicare program through various policies that target traditional fee-for-service, Medicare Advantage, and Accountable Care Organizations (ACOs). For example, it expands and extends the Independence at Home program, which allows seniors with multiple, complex, and expensive chronic conditions to receive specialized care at home from a team of healthcare providers. It is also expected to improve flexibility and predictability in the Medicare Advantage plan, to better serve those that are chronically ill through: (1) value-based insurance design, allowing MA plans in each state to tailor coordination and benefits to specific patient groups, in contrast to current law requiring uniform benefits; (2) a permanent expansion of special needs plans (SNPs); and (3) expanding supplemental benefits to better address the underlying causes of chronic illness.
It will further establish a program that allows certain Accountable Care Organizations (ACOs) to use their own money to help assigned patients afford primary care services needed to manage the individual’s chronic conditions, and give certain ACOs the option to have beneficiaries assigned at the beginning of a performance year, providing them with increased financial predictability and certainty along with the flexibility to target needed services to individuals suffering from chronic conditions.
The bill is also expected to have an impact on telehealth. For example, it: allows an MA plan to include additional telehealth services in its bid; gives certain ACOs more flexibility to provide telehealth services; allows beneficiaries receiving dialysis treatments at home to do their monthly check-in with their doctor via telehealth, rather than having to travel to the doctor’s office or hospital; and expands the availability of telehealth to ensure individuals who may be having a stroke receive the correct diagnosis and treatment.
The Finance Committee notes that six policies championed by the Chronic Care working group were either signed into law or executed administratively in 2016. Those include two provisions in the 21st Century Cures Act – improving risk adjustment and giving Medicare-eligible individuals with end-stage renal disease access to the Medicare Advantage program – and four policies included in the 2017 Medicare Physician Fee Schedule Final Rule -- expanding the Diabetes Prevention Program model; providing enhanced payment for additional care management services for beneficiaries with chronic conditions; promoting the integration of behavioral health care and primary care services; and establishing a new code to pay for assessment and care planning for beneficiaries with Alzheimer’s disease and other cognitive impairments.
A section-by-section summary of the CHRONIC Care Act of 2017 can be found here.