senate-proposes-medicare-facelift-chronically-illConsidering the fact that there has been so much political tension crackling along party lines when it comes to healthcare, one would think a bipartisan measure emerging from the Senate would have electrified the headlines. However, what the achievement lacked in fanfare it made up for with noteworthy lawmaker support: the bill cleared the Senate with unanimous approval.

Realistically, of course, the initiative may not make it through the House, but it’s worth taking a closer look at just the same.

CHRONIC proves that bipartisanship is not the stuff of fairy tales

Spearheaded by Senate Finance Committee’s Chronic Care Working Group, The Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care (CHRONIC) Act of 2017 has sponsors on both sides of the aisle: Senate Finance Committee Chair Orrin Hatch (R-Ut.), top committee Democrat Ron Wyden (D-Or.), along with members John Warner (D-Va.) and Johnny Isakson (R-Ga.).

In a nutshell, the bill would allow Medicare managed care plans to provide chronically ill seniors with non-medical and long-term supports and services when necessary. Additionally, CHRONIC would bolster access to telehealth services and add resources to a program that provides in-home care to seniors with complex conditions.

Committee urges Medicare to offer “consistent, high-quality, coordinated care”

The Committee released an informational statement about CHRONIC that includes this introduction:

“An increasing number of adults who will age into the Medicare program over the next two decades live with multiple chronic conditions, and more than two-thirds of beneficiaries in the program today have multiple chronic conditions. Chronically ill patients account for a large percentage of overall Medicare spending, which will continue to grow until the program provides consistent, high-quality, coordinated care for these individuals.”

At present, Medicare beneficiaries can only receive a short stint with home health services following hospitalization of three or more days. In addition to needing the assistance of a healthcare practitioner like a home health aide to help ensure care markers are being met, many chronically ill seniors are in need of basic but necessary assistance such as meals or transportation to see their doctors.

For the most part, Medicare fails to provide beneficiaries with these types of services on a long-term basis, which can spell catastrophe for individuals without friends or extended family able to provide at-home support.

Although Medicaid, on the other hand, often covers some of these support services, they don’t cover them for everyone. For instance, if an individual’s income puts him/her above the Medicaid threshold, there would be no coverage for the type of care that CHRONIC is proposing for individuals under the managed care umbrella.

Bill seeks to build customization in to Medicare Advantage plans for those with chronic conditions

 Around one-third of all Medicare beneficiaries participate in Medicare Advantage plans, plans that do not provide members with non-medical or long-term support services. If it becomes law, CHRONIC would open a pathway toward changing that.

Currently, anyone who in insured under a Medicare Advantage plan has coverage exactly like any other enrollee, no matter where they each fall on the spectrum of health status and unique medical needs. CHRONIC relaxes that mirror-benefit stipulation; rather, the measure would permit Medicare Advantage plans to offer certain health-related “supplemental benefits” to their enrollees living with chronic health conditions.

The bill defines the chronically ill as “those who have one or more comorbid and medically complex chronic conditions that are life threatening or significantly limit the overall health or functioning of the enrollee, have a high risk of hospitalization or other adverse health outcomes, and require intensive care coordination.”

Supplemental benefits must be intended to “prevent, cure, or diminish an illness or injury,” and are distinguished from services “that are primarily for comfort or are considered social services,” which would not be covered under this particular provision. The bill’s summary also includes some examples of supplemental benefits, which range from alternative therapies like acupuncture, counseling, and “enhanced disease management.”

CHRONIC has special plans for Special Needs Plans

Additionally, the bill deals with SNPs, or Special Needs Plans. Almost two-and-a-half million Americans are currently enrolled in SNPs, managed care plans that have been considered temporary, although they’ve been in existence for years.

CHRONIC would make SNPs permanent. More than four-fifths of people in SNPs meet eligibility for Medicare and Medicaid (therefore, the plans are known as “D-SNPs” since they cover those that are dually eligible).

But beyond making SNPs permanent, CHRONIC would require the plans to coordinate medical and non-medical services, for instance in the case where an enrollee receives medical care on the Medicare side and later needs long-term support and services from the Medicaid side. The bill seeks to grant states enough latitude to create guidelines for D-SNPs, but it also includes provisions for empowering beneficiaries through a stronger appeals process.

This blog post is provided for educational purposes only and is not offered as, and should not be relied on as, legal advice. Any individual or entity reading this information should consult an attorney for their particular situation. For more information/questions regarding any legal matters, please email or call 310.203.2800.