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DelBene, Welch Bill to Improve Care Coordination of Seniors on Medicare Passes in Ways & Means Committee

June 27, 2019
Press Release

Washington, D.C. – The Ways & Means Committee approved the Seniors’ Chronic Care Management Improvement Act (H.R. 3436), introduced by Reps. Suzan DelBene (D-WA) and Peter Welch (D-VT). The bill eliminates coinsurance requirements for chronic care management (CCM) services which are non-patient facing, non-clinical services that providers perform behind the scenes to better coordinate care for Medicare beneficiaries with two or more chronic conditions.

“Removing the copay for chronic care management services is a commonsense action Congress can take that will make it easier for doctors and nurses to provide care coordination for their sickest patients. Chronic conditions account for 90 percent of our nation’s health care spending and this is a meaningful way to address that. I look forward to having this measure voted on by the full House of Representatives,” said Rep. DelBene.

“Patients with chronic illnesses should not be receiving confusing bills even when they do not go to their physician,” said Welch. “Eliminating copays for chronic care management will stop confusing bills for American seniors living with chronic conditions and allow doctors to focus on their work. This is a simple and substantial way to streamline care for our nation’s seniors.”

CCM services include:

  • Recording of patient information using certified EHR technology,
  • providing 24/7 access to providers,
  • designating a team member to schedule future appointments,
  • systematic assessment of the patient’s medical, functional, and psychosocial needs,
  • medication reconciliation and adherence,
  • creation of a comprehensive care plan,
  • transmission of documents to ensure continuity of care during care transitions,
  • coordination with home and community-based providers, and
  • enhancing communication options (secure messaging, etc.).

CCM is done each month, and while physicians are required to get consent from their patients before providing these services, it is confusing to seniors to get a bill from their doctor when they did not have an appointment. This creates a scenario where physicians must take time to explain to their patients the work they are doing behind the scenes. The coinsurance is small, usually 8 dollars for the month, but providers are obligated to comply with Medicare rules and make an honest effort to collect that payment.

CCM can help improve patient outcomes but the use of CCM is sorely underutilized. In the first two years of the chronic care management payment policy, of the 35 million eligible Medicare beneficiaries only 684,000, less than two percent of patients, received such services. The clear majority of patients are not benefiting from coordinated care. 

According to the Centers for Disease Control (CDC), 25 percent of adults in the United States are living with two or more chronic conditions, with cancer and heart disease accounting for the most deaths.