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Rare Bipartisanship as Senate Passes Medicare Reform Bill

The Senate yesterday unanimously approved a bill to give Medicare providers ― including accountable care organizations, Medicare Advantage plans, and clinicians ― more flexibility by delivering care at home or using telehealth or team-based care to manage beneficiaries' chronic conditions.

The Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care (CHRONIC) Act of 2017 was put together by Republicans and Democrats on the Senate Finance Committee's Chronic Care Working Group, and it received the backing of every senator in a floor vote.

'The CHRONIC Care Act is a culmination of a bipartisan, committee-wide effort, which included rigorous engagement and feedback from affected stakeholders,' said Finance Committee Chairman Orrin Hatch (R-UT) in a statement. 'This legislation will improve disease management, lower Medicare costs, and streamline care coordination services ― all without adding to the deficit,' he said.

In August, the Congressional Budget Office estimated that if the bill became law, it would not affect direct spending in fiscal year 2018 and would reduce direct spending for the Medicare and Medicaid programs by $217 million from 2018 to 2022.

'The CHRONIC Care Act will mean more care at home and less in institutions,' said Ron Wyden, the top Democrat on the Finance Committee, in a floor statement before the vote. 'It will expand the use of lifesaving technology. It places a stronger focus on primary care. It gives seniors, however they get Medicare, more tools and options to receive care specifically targeted to address their chronic illnesses and keep them healthy,' said Wyden, of Utah.

The Senate bill proposes to extend the Medicare Independence at Home (IAH) demonstration project, which was established by the Affordable Care Act. The program ― which expired September 30 ― pays a primary care team to make in-home visits to address chronic conditions. The Senate wants it continued until September 2019 and to increase the cap on the total number of participating beneficiaries from 10,000 to 15,000. They also want to give practices 3 years to receive a shared savings payment (instead of the 2 years now required).

The CHRONIC Care Act also would expand the number of Medicare beneficiaries on dialysis who can receive telehealth consultations, allow a Medicare Advantage plan to offer a wider array of supplemental benefits ― such as fitness, counseling, and acupuncture ― to chronically ill enrollees beginning in 2020, and expand the amount that Medicare Advantage plans could be paid so that some telehealth services could be offered.

Telehealth opportunities would also be expanded for beneficiaries in accountable care organizations or having a stroke.

The House has not introduced a companion bill, but it has several proposals that would cover some of the same benefits called for by the CHRONIC Care Act.

Hatch called on his fellow lawmakers in the House to follow the Senate's lead. 'I urge my colleagues in the House to act quickly on this legislation and get it to the president's desk to be signed into law,' he said.

Alicia Ault

September 27, 2017