AMGA Endorses Chronic Care Legislation
Eliminating Medicare Cost-Sharing Requirement Supports Care Management
Alexandria, VA – AMGA encourages Congress to swiftly pass legislation introduced yesterday to eliminate beneficiary cost-sharing requirements for chronic care management (CCM) services. AMGA applauds the work of Rep. Suzan DelBene (D-WA), who drafted the legislation to improve a tool which our members can use to support the care management services that are a key aspect of treating chronic illnesses.
“Medicare beneficiaries with chronic diseases face so many challenges,” said AMGA President and CEO Jerry Penso, M.D., M.B.A. “While it may not seem like much, removing the cost-sharing requirements for these services will allow patients to focus on their treatments and care without worrying about their out-of-pocket expenses.”
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. AMGA strongly supported the creation of the CCM code, which reimburses providers for services 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. AMGA members provided such care before the creation of the code, which was developed in recognition of the need to support the ability of providers to deliver such treatment.
Creating a separately billable code, however, resulted in new beneficiary cost-sharing obligations, which contribute 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 has recommend that Congress eliminate the cost-sharing requirement to help fulfill the code’s potential and remove an unintended barrier to its use. AMGA appreciates that Rep. DelBene recognized the need for reform and strongly endorses her legislation. Congress should enact this legislation as quickly as possible.
“AMGA would like to thank Rep. Suzan DelBene for her leadership on this issue,” Penso added. “Her efforts to further this legislation demonstrate a commitment not only to patients with chronic disease, but the providers who are working to deliver the best possible care to them.”
AMGA's official support 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.
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