Healthcare Stakeholder Groups Endorse Chronic Care Legislation Reform
Call for Elimination of Chronic Care Management Cost-Sharing Requirement
Alexandria, VA – AMGA and 13 healthcare stakeholder groups endorsed bipartisan legislation introduced today by Rep. Suzan DelBene (D-WA) that seeks to remove patient cost-sharing requirements for chronic care management (CCM) services under Medicare. The bill, called the “Seniors’ Chronic Care Management Improvement Act of 2021 (H.R.4755),” would waive the cost-sharing requirements for CCM services, thus enabling a greater portion of the more than 35 million Medicare beneficiaries with two or more chronic conditions to gain access to better coordinated care.
In 2015, the Centers for Medicare & Medicaid Services began paying for CCM under a separate code to reimburse providers for non-face-to-face care management in the Medicare Physician Fee Schedule. This code reimburses providers for services primarily outside of an office visit to help individuals with two or more chronic conditions follow their medical care plan, practice preventive health care, and more effectively manage their health. The code covers services such as care management, medication management, and preventive health counseling, among others, and was created in recognition of the need to support providers’ ability to deliver such treatment.
However, creating a separately billable code resulted in new cost-sharing obligations, whereby Medicare beneficiaries are subject to a 20% coinsurance requirement in order to receive CCM services. These obligations have contributed to low utilization of the code. For example, only about 684,000 Medicare beneficiaries received CCM services during the first two years of the code’s availability. AMGA strongly recommends Congress eliminate the CCM code’s cost-sharing requirement to help fulfill its potential and remove an unintended barrier to its use.
“Medicare beneficiaries with multiple chronic conditions already face challenges,” said AMGA President and CEO Jerry Penso, M.D., M.B.A. “Removing cost-sharing requirements from CCM services will eliminate one of those challenges and help those patients to focus on their care. We are grateful for Rep. Delbene’s leadership on this important issue and believe eliminating the requirement will improve the care for millions of senior citizens.”
Stakeholder groups that have signed the letter of support include:
- American Academy of Family Physicians
- American College of Physicians
- American Diabetes Association
- American Medical Association
- American Osteopathic Association
- America’s Physician Groups
- Association of American Medical Colleges
- Health Care Transformation Task Force
- Healthcare Leadership Council
- Medical Group Management Association
- National Association of ACOs
- Premier healthcare alliance
A copy of the letter can be found here.
AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans. For more information, visit amga.org.
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