The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S.870), sponsored by Sens. Ron Wyden (D-Ore.), Mark Warner (D-Va.) and Johnny Isakson (R-Ga.), was passed in the Senate last week. The bipartisan CHRONIC Care Act of 2017 promises to improve home-based care, increase Medicare Advantage flexibility, gives Accountable Care Organizations (ACOs) more options, and expands telehealth utilization.
“This bill provides new options and tools for seniors and their doctors to coordinate care and makes it less burdensome to stay healthy,” according to Sen. Ron Wyden, D-Ore.
According to one report:
1. It extends the ACA’s Independent at Home program. This program began under the ACA in 2012. It serves as a demonstration to allow primary care teams to provide at-home care for 10,000 Medicare beneficiaries with complex chronic conditions. Due to the success of the demonstration, the CHRONIC Care Act would extend the program for two more years. Additionally it will increase the number of participating beneficiaries to 15,000.
2. The bill expands flexibility for Medicare Advantage. Specifically, the bill would allow MA plans in all states to participate in the Value-based Insurance Design model. This allows MA plans to tailor benefits to specific patient groups, particularly those with chronic conditions. Currently MA plans must offer uniform benefits. The CHRONIC Care Act would also allow MA plans to offer a greater range of supplemental benefits for services that address the underlying causes of illness, such as fitness, counseling or alternative therapies. Additionally, the bill would permanently authorize MA Special Needs Plans for patients who are institutionalized, dually eligible for Medicare and Medicaid or who have severe chronic illness.
3. The bill loosens ACO regulations. Under the legislation, ACOs will provide incentive payments to beneficiaries for certain primary care services; it would allow for prospective, rather than retrospective, beneficiary assignment for Medicare Shared Savings Program ACOs; and it would give Pioneer ACOs and MSSP Tracks 2 and 3 ACOs more options to provide telehealth and receive reimbursement for those services.
4. Lastly, the CHRONIC Care Act would broaden telehealth options for Medicare and MA plans. In addition to adding more pathways for telehealth reimbursement for ACOs, the bill would allow MA plans to include more telehealth options. It also expands telestroke care and telemedicine for dialysis care. Under the bill, dialysis patients could conduct e-visits from home in lieu of an in-person monthly appointment.
CBO Scores CHRONIC Care Act of 2017
In the spring, the Congressional Budget Office (CBO) scored the CHRONIC Care Act of 2017 very favorably. Among its findings were:
- Medicare reimbursements for telestroke would likely boost spending by $180 million over the next decade. Alternatively, adding telehealth to ACOs would cost about $100 million – $50 million. Consequely, this would give ACOs more flexibility to use the technology, and $50 million to expand the ACO population to include beneficiaries with chronic conditions.
- Adding telehealth to Medicare Advantage plans to meet the needs of chronically ill enrollees would add another $90 million. In so doing, it would provide access to MA special needs plans for vulnerable populations would add $123 million over the next decade.
- Increases would be offset by a projected $80 million in savings. These savings would be realized in MA plans through “increased convenience” for enrollees and an estimated $375 million saved with the expected elimination of the Medicare and Medicaid Improvement Funds.
The CHRONIC Care Act of 2017 will now go to the house for consideration.