In the din of the debate over what to do with the Affordable Care Act, it was hard to notice that the Senate Finance Committee reported out a bill a couple weeks ago which represents long standing bipartisan agreement on Medicare policy for chronic conditions.
With the tortured title of “Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017” written by acronym-obsessed Hill staff, the bill is better known as the CHRONIC Act and has been a project of Sen Ron Wyden (D) of Oregon for several years.
What the bill does:
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Continues federal policy to encourage home dialysis by permitting use of telemedicine services for required monthly visits with physician beginning Jan. 1, 2019;
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Permits Medicare Advantage plans to offer Special Needs Plans to certain populations beyond 2019 when current law would eliminate them;
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Requires greater coordination between Medicare and state Medicaid programs for SNPs beginning in 2020 and refines the definition of a special needs beneficiaries effective in 2022;
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Adds new requirements for SNPs designed for individuals with severe or chronic disabling conditions including goal-setting and benchmarking;
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Establishes a procedure for identifying conditions that are considered disabling and chronic effective in 2020;
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Allows HHS Secretary to establish quality measures at the plan level instead of the contract level for SNPs as well as all Medicare Advantage plans;
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Permits the testing of a Medicare Advantage value-based design for chronically ill beneficiaries that would permit MA plans to vary benefit design and cost-sharing for beneficiaries in Oregon, Arizona, Texas, Iowa, Michigan, Indiana, Tennessee, Alabama, Pennsylvania and Massachusetts and expanded to all states by 2020;
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Expands supplemental benefits to chronically ill enrollees that are not limited to primarily health related services effective in 2020;
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Permits MA plans to use telehealth services and be reimbursed under Part B in 2020;
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Permits use of telehealth services for the purposes of evaluating an acute stroke in 2019;
Why you care:
It will pass. The question is: when?. There are a number of vehicles available in the coming months – CHIP re-authorization, Medicare extenders and, of course, health care reform to which it could hitch a ride so look for the bill to become law by the end of 2017.
The bill adds speed to the Medicare Advantage tailwinds created by a very friendly political environment. Democrats’ resistance to the Medicare Advantage program has diminished in recent years as enrollment and the popularity of the plans has increased. For their part, Republicans would be perfectly happy if every Medicare beneficiary was enrolled in a Medicare Advantage plan.
The bill makes it possible for MA plans to vary benefit design, supplemental benefits and cost sharing for chronically ill enrollees in select states with expansion nationally in 2020. The bill makes a distinction between the chronically ill and those eligible for Special Needs Plans. A chronically ill individual:
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has one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits the overall health or function of the enrollee;
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has a high risk of hospitalization or other adverse health outcomes; and
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requires intensive care coordination.
It is the supplemental benefits of MA plans that generally make them attractive to enrollees. Current law restricts supplemental benefits to health related services. Dental and vision coverage are the most common supplemental benefits found in the MA program. The Senate wants to permit greater variation in supplemental benefits and to expand them beyond health services. Uber rides to doctor appointments could, then, become a supplemental benefit.
A recent RAND study found that 59 percent of Americans had one or more chronic conditions and accounted for 90 percent of health care spending.
Overall, this flexibility and enhanced ability to attract enrollees is great news for AET, HUM, UNH, CI, WCG,
The bill also relaxes the archaic – no, let’s call it prehistoric – rules on the delivery of telehealth services. The senate bill would permit Medicare Advantage plans to provide telehealth services for reimbursement under Part B provided they are clinically appropriate.
Standing in the way of modernization of telehealth services in the Medicare program has been the program integrity crowd at HHS who get the heebie-jeebies at the thought of trying to trying to regulate phone calls. The Senate has found a way, by largely permitting growth in the servicesunder the watchful eye of MA plan sponsors, to assuage those concerns.
More good news for MA plan sponsors like AET, HUM, UNH, CI and WCG who can provide services through the low cost channel of a phone call. The bill is also good news for TDOC who offers a turnkey telehealth response to this new opportunity for AET, one of their existing clients.
Home Dialysis continues to be a congressional priority. Recall that the last ESRD payment update included an increase in the home training payment. Since then we have sat through a number of meetings with Hill staff and Members of Congress who have repeatedly cited home care for dialysis and stroke as priorities.
The CHRONIC Act would permit home dialysis patient to make their required monthly visit with their physician via telehealth services so long as once a quarter they had a face-to-face encounter. The bill would mean one less reason for an ESRD patient to visit a dialysis clinic.
Making it easier for ESRD patients to get treated and speak with their doctor from home is bad news for DVA and FMS whose business model seems increasingly under regulatory stress. The change, however, would be good news for NXTM whose devices support home dialysis care.
Begins to address the almost near scandalous way in which dual eligible populations are served. It is often said that had Medicare and Medicaid set out to design the worst possible way to serve these vulnerable populations, they could not have done any better than the system as it is today. The competing financing mechanism, budget priorities and reimbursement rates of Medicare and Medicaid have resulted in poor care coordination and increased costs.
The CHRONIC Act would make permanent MA Special Needs Plans, which current law sunsets in 2019.It would also require SNP plans be designed to integrate with state Medicaid programs.
It is hard to say who benefits from this change in law other than dual eligible beneficiaries. The elimination of the 2019 sunset brings some certainty to MA SNP providers but success for plans will depend on state level execution.
Call with questions. The Senate comes back to work next week so we will be at our station keeping an eye on them.
Emily Evans
Managing Director
Health Policy
@HedgeyeEEvans
