CHRONIC Care Act Introduced in Senate

By David White

In January, the Government Accountability Office (GAO) released a new report detailing that 17% of Americans (40 million) have kidney diseases and about 680,000 have kidney failure.  Overall, an increasing number of adults who will age into the Medicare program over the next two decades live with multiple chronic conditions – more than two-thirds of beneficiaries in the program today have multiple chronic conditions. Chronically ill patients account for a large percentage of overall Medicare spending – the GAO data shows that Medicare spends nearly $33 billion on kidney failure alone – and will continue to grow creating a demand for programs that provide consistent, high-quality, and coordinated care for these individuals. 

In response to this pressing need, the Senate Finance Committee created the Finance Committee Chronic Care Working Group, which has been seeking bipartisan policy solutions in chronic care. Now, the leadership of both the Finance Committee and the Chronic Care Working Group have drafted and introduced the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act (S. 870), a bipartisan bill to strengthen and improve health outcomes for Medicare beneficiaries living with chronic conditions.

For nearly two years, ASN, the Alliance for Home Dialysis, and other stakeholders, advocated for kidney-specific provisions for this legislation. Important to nephrologists and their patients, S. 870 includes a provision that would permit home dialysis patients to interface with their nephrologist via telehealth from their homes. If enacted, home dialysis patients would be the first-ever Medicare patient population permitted to use telehealth services from their home, putting nephrology at the forefront of a burgeoning trend.  

The Chronic Care Act was introduced with strong support by Senate Finance Committee Chairman Orrin Hatch, (R-Utah) and Ranking Member Ron Wyden, (D-Ore.). Along with Senators Johnny Isakson, (R-Ga.), and Mark Warner, (D-Va.), co-chairs of the Chronic Care Working Group.

Last year, the Chronic Care Working Group worked with the Centers for Medicare and Medicaid Services (CMS) on four areas to improve care for Medicare beneficiaries with chronic illness. They include:

•     Chronic Care Management giving providers a higher payment if they spend more time actively coordinating care for chronically ill patients.

•     Integrated Behavioral Health Care providing new payments for those who integrate primary care and mental health/substance use disorder treatment.

•     Better Care for Patients with Cognitive Impairments creating a new opportunity for patients with Alzheimer’s disease and other cognitive impairments to receive an assessment and engage in care planning with      their doctors to help manage these debilitating conditions. 

•     Diabetes Prevention encouraging providers to help people at risk of developing diabetes with education and prevention. 

In addition, the 21st Century Cures Act (P.L. 114-255), signed into law on December 13, 2016, included two important CHRONIC Care Act provisions improving risk adjustment in the Medicare Advantage (MA) program and ensuring access to MA plans for Medicare-eligible individuals with end-stage renal disease.

More updates to come on the CHRONIC Care Act as it makes its way through Congress. See the bill's text and progression here.

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In January, the Government Accountability Office (GAO) released a new report detailing that 17% of Americans (40 million) have kidney diseases and about 680,000 have kidney failure.  Overall, an increasing number of adults who will age into the Medicare program over the next two decades live with multiple chronic conditions – more than two-thirds of beneficiaries in the program today have multiple chronic conditions. Chronically ill patients account for a large percentage of overall Medicare spending – the GAO data shows that Medicare spends nearly $33 billion on kidney failure alone – and will continue to grow creating a demand for programs that provide consistent, high-quality, and coordinated care for these individuals. 

In response to this pressing need, the Senate Finance Committee created the Finance Committee Chronic Care Working Group, which has been seeking bipartisan policy solutions in chronic care. Now, the leadership of both the Finance Committee and the Chronic Care Working Group have drafted and introduced the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act (S. 870), a bipartisan bill to strengthen and improve health outcomes for Medicare beneficiaries living with chronic conditions.

For nearly two years, ASN, the Alliance for Home Dialysis, and other stakeholders, advocated for kidney-specific provisions for this legislation. Important to nephrologists and their patients, S. 870 includes a provision that would permit home dialysis patients to interface with their nephrologist via telehealth from their homes. If enacted, home dialysis patients would be the first-ever Medicare patient population permitted to use telehealth services from their home, putting nephrology at the forefront of a burgeoning trend.  

The Chronic Care Act was introduced with strong support by Senate Finance Committee Chairman Orrin Hatch, (R-Utah) and Ranking Member Ron Wyden, (D-Ore.). Along with Senators Johnny Isakson, (R-Ga.), and Mark Warner, (D-Va.), co-chairs of the Chronic Care Working Group.

Last year, the Chronic Care Working Group worked with the Centers for Medicare and Medicaid Services (CMS) on four areas to improve care for Medicare beneficiaries with chronic illness. They include:

•     Chronic Care Management giving providers a higher payment if they spend more time actively coordinating care for chronically ill patients.

•     Integrated Behavioral Health Care providing new payments for those who integrate primary care and mental health/substance use disorder treatment.

•     Better Care for Patients with Cognitive Impairments creating a new opportunity for patients with Alzheimer’s disease and other cognitive impairments to receive an assessment and engage in care planning with      their doctors to help manage these debilitating conditions. 

•     Diabetes Prevention encouraging providers to help people at risk of developing diabetes with education and prevention. 

In addition, the 21st Century Cures Act (P.L. 114-255), signed into law on December 13, 2016, included two important CHRONIC Care Act provisions improving risk adjustment in the Medicare Advantage (MA) program and ensuring access to MA plans for Medicare-eligible individuals with end-stage renal disease.

More updates to come on the CHRONIC Care Act as it makes its way through Congress. See the bill's text and progression here.