Healthcare Stakeholder Groups Endorse Chronic Care Legislation Reform

Alexandria, VA – AMGA and 31 healthcare stakeholder groups endorsed bipartisan legislation, the Chronic Care Management Improvement Act of 2023, to waive beneficiary cost-sharing requirements for Chronic Care Management (CCM) services to improve care coordination for the more than 22.5 million Medicare beneficiaries with chronic disease. While Medicare has covered CCM services since 2015, AMGA members have found beneficiary cost-sharing creates a barrier to care management services, as Medicare beneficiaries do not understand why they are charged for non-face-to-face care management. 

“Chronically ill patients face numerous challenges on a daily basis,” said AMGA President and CEO Jerry Penso, MD, MBA. “Removing cost-sharing requirements from CCM services will eliminate one of those challenges and allow providers to focus on patient care coordination.”

In the 2015 Medicare Physician Fee Schedule, the Centers for Medicare & Medicaid Services (CMS) began paying for CCM under a separate code to reimburse providers for non-face-to-face care management. 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 for Medicare beneficiaries and resulted in low utilization of the code. Only about 882,000, or 4%, of Medicare beneficiaries eligible for CCM, received these services. AMGA and the other stakeholders strongly recommend Congress eliminate the CCM code’s cost-sharing requirement to help fulfill its potential and remove an unintended barrier to its use.

The “Chronic Care Management Improvement Act of 2023,” introduced today by Rep. Suzan DelBene (D-WA) and Jeff Duncan (R-SC) would solve this problem by eliminating the patient cost-sharing requirements for CCM services under Medicare. 

“We are grateful for the leadership of Reps. DelBene and Duncan and believe that removing this beneficiary cost-sharing requirement will improvement access and quality of care for millions of senior citizens,” Penso added.

The letter is available on AMGA’s website.

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About AMGA

AMGA is a trade association leading the transformation of healthcare 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. 

AMGA represents medical groups and integrated systems of care. Its diverse membership includes multispecialty medical groups, integrated delivery systems, accountable care organizations, and other entities committed to improving healthcare outcomes. AMGA advocates for the formation of innovative, clinically integrated systems of care that advance population health, enhance patient experience, and reduce healthcare costs. For more information, please visit www.amga.org.