US Senate Passes Legislation Extending Demonstration Project on Chronic Care Management
April 28, 2015 10:15 AM
The US Senate last week passed by voice vote legislation that would provide for the continuation of a physician-based chronic care management demonstration program established under the Affordable Care Act (ACA). The Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 extends for two years a demonstration project known as Independence at Home (IAH). The model focuses on certain high risk categories of chronic care patients, using a reimbursement method that shares the Medicare spending savings between Medicare and providers.
The legislation was sponsored by Senate Finance Committee Chairman Ron Wyden (D-OR), with cosponsors Senator Edward J. Markey (D-MA), Senator Michael Bennet (D-CO), Senator Richard Burr (R-NC), and Senator Johnny Isakson (R-GA).
“We are delighted to commend Senator Wyden and Senator Markey, along with Senator Bennet, Senator Burr, and Senator Isakson, for their advocacy for legislation that helps keep people at home,” said Val J. Halamandaris, President of the National Association for Home Care & Hospice.
Senator Markey said this legislation will “help save money” and “increase the peace of mind” of senior patients. “The Independence at Home program is moving quality health care from emergency rooms to living rooms for our most vulnerable seniors,” said Senator Markey. “This pilot program extension will allow teams of doctors and nurses to continue to care for severely ill Medicare patients in the home, bringing the house calls of yesteryear into the 21st century.”
Senator Wyden has similarly described the legislation as both a cost-savings measure and one that will improve health outcomes for seniors. “With Independence at Home, we have an opportunity to both improve the health outcomes for thousands of Medicare beneficiaries and to dramatically reduce the cost of treating these most expensive patients at the same time,” said Senator Wydensaid about the program in 2012. “Congressman Markey and I have worked for years to see home-based healthcare brought to the Medicare system but we still have work to do.”
The US House has not yet considered the legislation. The bill has been referred to the House Ways & Means Committee and the House Energy & Commerce Committee.
NAHC agrees that chronic illness requires different services and supports than are currently covered under the traditional acute care benefit structure of Medicare. The current system does not adequately provide coverage for supportive, preventative, and care management services for the chronically ill. This results in costly hospitalizations, emergent care, and exacerbations of underlying illness.
While NAHC is supportive of the legislation and IAH, NAHC is advocating for an expanded focus on chronic care management with a broader population than IAH addresses. NAHC recommends that Congress monitor Medicare demonstration programs and pilot projects to ensure the Centers for Medicare & Medicaid Services complies with Congress’s mandates and recommendations.
NAHC further argues that, based on the outcomes of the various demonstration projects and pilot programs, Congress should establish a separate care management benefit under Medicare for certain chronically ill, including chronic obstructive pulmonary disease, congestive heart failure, diabetic, and certain neurological disorder-afflicted patients. In order to ensure a discipline-integrated, community care-based approach to care management, the service should be provided by professional nurses and others within home health agencies, under the guidance and supervision of the patient’s attending physician as a member of the care team. The services should include: 1) An interdisciplinary team approach to care management that includes physicians, nurses, therapists, medical social workers, and pharmacists; 2) Evidence-based care plan development; 3) Direct patient care services in the home setting; 4) The application of telehealth services for appropriate remote monitoring as needed by the individual patient; 5) Care counseling, care coordination, medication management, and oversight of services related to activities of daily living; 6) The use of interoperable electronic health care records and efficient electronic-based communication tools; 7) Patient education and support; and 8) Integration and support of informal caregivers such as family members.
This care management benefit could help prevent the complications and costs under the existing Medicare benefit structure, which encourages individuals to wait until their condition deteriorates before addressing them. Home health agencies that possess the skill and experience to manage chronically ill individuals in the community are already available to provide a chronic care management delivery system.
NAHC will continue to provide updates regarding further action on S. 971, as well as other efforts to improve chronic care management.