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The passing of the CHRONIC Care Act = reimbursement for Medicare and MA plans.

September 28, 2017 by Emily Rappleye

The Senate passed a bipartisan bill Tuesday night to improve care coordination for patients with multiple chronic conditions.

The bill, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017, aims to improve at-home care, increase Medicare Advantage flexibility, give ACOs more options and expands telehealth capabilities.

“This bill provides new options and tools for seniors and their doctors to coordinate care and makes it less burdensome to stay healthy,” Sen. Ron Wyden, D-Ore., said in a statement.

Here are four things to know about how the CHRONIC Care Act would reform Medicare.

1. It extends the ACA’s Independent at Home program. This program was started in 2012 under the ACA 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 and 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, which 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 would be allowed to 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, and it would expand 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, so long as they visit their provider face-to-face once every three months.

Now that the Senate has passed the bill, the House will take up discussion of the CHRONIC Care Act.

 

 

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