The CHRONIC Care Act is focused on improving the quality of care for the chronically ill via better chronic disease management using telehealth and other innovative technology. Stakeholders have long claimed the bill was essentially a ‘no-brainer’ as evidenced by strong bipartisan support and 21 cosponsors. It’s also worth noting that CBO found enacting the CHRONIC Care Act would not adversely affect total direct spending over the next decade. The CHRONIC Care Act successfully passed the Senate on September 26, 2017 but shortly thereafter stalled and was awaiting action in the House of Representatives until it was included as part of the Bipartisan Budget Act of 2018 (BBA) which President Trump signed into law on February 9, 2018.
As passed under the BBA, the CHRONIC Care Act has six sections or subtitles: receiving high quality care in the home, advancing team based care, expanding innovation and technology, identifying the chronically ill population, empowering individuals and caregivers in care delivery, and other policies to improve care for the chronically ill. Subtitle A extends the Affordable Care Act (ACA) Independence at Home (IAH) program by two years and increases the number of eligible beneficiaries by 5,000. It also expands access to telehealth for those needing dialysis. Subtitle B includes provisions focused on supporting access to Medicare Advantage (MA) special needs plans (SNPs) for vulnerable persons by making the program permanent rather than subject to extensions from Congress. It also provides a targeted focus on increasing the integration of dual SNPs to improve coordination with state Medicaid agencies.
Subtitle C aims to expand the use of innovation to better meet the needs of chronically ill MA enrollees and has far reaching implications. This section of the BBA includes the proposed testing of a value based insurance model aimed at enhancing MA plans’ flexibility, expanding the use of supplemental benefits for MA enrollees, promotes telehealth as a convenient care option and expands its use within accountable care organizations (ACOs). The supplemental benefits are aimed at accounting for some of the upstream factors that affect one’s health status so enhancing these should improve one’s overall wellbeing. In part, Subtitle D would increase flexibility for beneficiaries to be part of ACOs by permitting ACOs to prospectively assign Medicare fee for service (FFS) beneficiaries rather than assign them retrospectively. Assigning beneficiaries prospectively should strengthen ACOs’ ability to design appropriate care plans and more importantly, effectively manage their risk. Subtitle E empowers individuals and their caregivers by giving them more ownership over the care they receive within ACOs through an incentive based payment program.
Subtitle C is considered monumental in its intent to vastly improve access to telehealth for chronically ill Medicare beneficiaries and those MA enrollees whom have had a stroke. By expanding the use of telehealth, Congress hopes to reduce the frequency of hospital visits which may result in a dramatic decline in Medicare costs. This should also enable hospital staff to focus their efforts and resources on treating acute, non-chronic patients. Giving patients the option to obtain tailored, individualized care in the comfort of their home should not only increase their sense of empowerment, but also improve their overall health status. The inclusion of this provision in the BBA signals that Congress recognizes the importance of telehealth and suggests that there is room to find bipartisan consensus on health reform.