Bill Waiving Chronic Care Cost-sharing Wins AAFP Support

Millions Would Benefit From Long-sought Policy

July 09, 2019 02:52 pm News Staff – The CDC says six in 10 Americans suffer from a chronic illness -- and four in 10 have two or more. Yet AAFP data indicate that fewer than half of family physicians provide chronic care management services to Medicare patients.

One reason: Medicare's CCM benefit, introduced in 2015, remains limited by CMS cost-sharing rules that impose administrative burdens on physicians while increasing both toll and confusion for beneficiaries.

The Academy has long pressed CMS and lawmakers to remove such co-insurance requirements for Medicare's CCM service codes. Now, a bill being considered in the House might finally do just that.

The Health Opportunities to Promote Equity Act (H.R. 3346), recently referred to the House Ways and Means Committee, would eliminate beneficiary cost-sharing for the CCM service codes starting in 2021.

The Academy signaled its enthusiasm for this progress by endorsing the bill in two June 25 letters to committee members.

Waiving CCM cost-sharing requirements would ultimately "increase coordination of care for those beneficiaries with the greatest health care needs," said a letter to the committee's chair and ranking member(2 page PDF) -- respectively, Reps. Richard Neal, D-Mass., and Kevin Brady, R-Texas -- signed by Board Chair Michael Munger, M.D., of Overland Park, Kan.

The Academy also co-signed a letter(1 page PDF) to Rep. Suzan DelBene, D-Wash., strongly endorsing another bill addressing CCM that she introduced.

That correspondence -- whose 13 other signers included the AMA and the Patient-Centered Primary Care Collaborative -- characterized the 20% co-insurance payments required of Medicare beneficiaries for CCM services as a significant barrier to care.

"Only 684,000 patients out of 35 million Medicare beneficiaries with two or more chronic conditions benefitted from CCM services over the first two years of the payment policy," the letter said.

Those patients, the letter added, had positive outcomes that included improved patient satisfaction and adherence to recommended therapies, improved clinician efficiency, and decreased hospitalizations and emergency department visits.

But that leaves more than 34 million other chronically afflicted people -- a population that stands to gain meaningful relief from H.R. 3346.

The AAFP's letter reminded the committee that removing CCM co-payments is not a new idea. A 2015 Senate Finance Committee working group produced a set of options for chronic care that included waiving beneficiary co-payments, though the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, which passed the Senate in 2017, did not include this policy.

Related AAFP News Coverage
Chronic Care Management
Utilize CCM Codes to Maximize Patient Care, Payment
(11/30/2018)