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Default Proposed legislation aimed at comorbidity among Medicare beneficiaries

Proposed legislation aimed at comorbidity among
Medicare beneficiaries

April 4, 2016

by Robert Gatty

A "policy options document" developed by the U.S. Senate Finance
Committee's Chronic Care Working Group could form the basis for new
legislation with a significant impact on the long-term care industry.

Issued last December following a series of hearings and stakeholder
meetings, the document suggests a series of options for the committee to
consider with the goal of improving how Medicare treats beneficiaries with
multiple, complex chronic illnesses. The Working Group says any policy
under consideration should meet these key objectives:

• Increase care coordination among individual providers across care
settings who are treating individuals living with chronic diseases;

• Streamline Medicare’s current payment systems to incentivize the
appropriate level of care; and

• Facilitate delivery of high-quality care, improve care
transitions, produce stronger patient outcomes, increase program
efficiency and contribute to an overall effort to reduce the growth in
Medicare spending.

Should the committee decide to move forward with its recommendations and
develop a final document, revised after submitted comments, that action is
expected to wait until the new Congress convenes in January 2017 when
lawmakers can return their focus to making improvements many consider
necessary while also reducing overall healthcare expenditures.

Policy Options

Some of the policy options in the document include:

• Expanding the Independence at Home Model of Care (IAH)
demonstration into a permanent, nationwide program.

• Expanding access to home hemodialysis therapy by including
free-standing renal dialysis facilities in its qualified originating site

• Requiring Medicare Advantage (MA) plans to offer the hospice
benefit provided under traditional Medicare.

• Allowing end stage renal disease beneficiaries to choose a MA
plan no matter when their condition began.

• Providing continued access to MA special needs plans (SNP) for
vulnerable populations through a long-term extension or permanent
authorization of SNPs as established under the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003.

• Improving care management services for individuals with multiple
chronic conditions by establishing a new high-severity chronic care
management code under the physician fee schedule.

• Developing policies to improve integration of care for
individuals with a chronic disease combined with a behavioral health

• Providing MA plans the flexibility to establish a benefit
structure that varies based on chronic conditions of individual enrollees.

• Expanding supplemental benefits for chronically ill MA enrollees.

• Using telehealth to increase convenience for MA enrollees and for
individuals who have suffered a stroke.

• Providing Accountable Care Organizations (ACO) the ability to
expand use of telehealth.

• Clarifying that ACOs participating in the Medicare Shared Savings
Program (MSSP) may furnish a social or transportation service for which
payment is not made under fee-for-service Medicare.

• Ensuring accurate payment for chronically ill individuals.

• Providing flexibility for beneficiaries to be part of an ACO.

• Developing quality measures for chronic conditions.

• Encouraging beneficiary use of chronic care management services.

• Establishing a one-time visit code post initial diagnosis of
Alzheimer’s disease, dementia or other serious or life-threatening

• Eliminating barriers to care coordination under ACOs.

• Expanding access to prediabetes education.

• Expanding access to digital coaching to help beneficiaries learn
more about their health conditions and in the self-management of their own

• Icreasing transparency at the Center for Medicare & Medicaid

• Conducting a study of medication synchronization.

• Conducting a study on obesity drugs.
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