AMGA Endorses Chronic Care Legislation Reform

Call for Elimination of Medicare’s Chronic Care Management Cost-Sharing Requirement

Alexandria, VA – AMGA and 39 healthcare stakeholder groups endorsed bipartisan legislation 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 that beneficiary cost-sharing creates a barrier to care management services, as beneficiaries are being billed for services that do not always include interfacing with their provider, leading to confusion for patients.

“Chronically ill patients face numerous challenges and are constantly interfacing with the healthcare system,” said AMGA President and CEO Jerry Penso, MD, MBA. “Removing cost-sharing requirements from CCM services will encourage patients and providers to engage in the care coordination necessary to manage complex health conditions in the most appropriate setting for the patient.” 

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. The code covers services such as structured recording of patient health information, maintaining comprehensive electronic care plans, managing care transitions and other care management services, as well as coordinating and promptly sharing patient health information within and outside the practice.

However, creating a separately billable code led to new cost-sharing obligations for Medicare beneficiaries and low utilization of the code. Only about 882,000 Medicare beneficiaries eligible for CCM received these services, or about 4% of eligible beneficiaries. AMGA strongly recommends that Congress eliminate the CCM code’s cost-sharing requirement to ensure this population receives care in the best setting for the patient.

The “Chronic Care Management Improvement Act of 2026,” introduced today by Reps. Suzan DelBene (D-WA) and Mike Kelly (R-PA), would solve this problem by eliminating patient cost-sharing requirements for CCM services under Medicare. 

“AMGA is grateful for the leadership of Reps. DelBene and Kelly and believe that removing this beneficiary cost-sharing requirement will improve care coordination and consequently better health outcomes 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.