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New Law Broadens Chronic Care Through Medicare

The CHRONIC Care Act expands access to telehealth and other benefits

Part of the Transforming Life as We Age Special Report

Older adults with a lot of medical issues will see some of their burdens eased through a new law passed by Congress and signed by President Donald Trump.

The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2018 won broad bipartisan support.

That makes sense, because “everybody knows somebody with serious chronic illness or functional limitations, and everybody knows somebody who’s faced a real challenge getting their care coordinated or accessing something that clearly ought to be a benefit,” said Dr. Bruce Chernof, president and CEO of The SCAN Foundation, a public charity devoted to transforming care for older adults to preserve dignity and encourage independence (and a Next Avenue funder).

The CHRONIC Care Act became law on Feb. 9 as a part of the Bipartisan Budget Act of 2018.

“The bill itself contains a broad array of opportunities to improve and better integrate care, particularly for high-needs older adults, so much of it is focused on Medicare,” Chernof said. Other parts of the law strengthen programs for those eligible for both Medicare and Medicaid.

Details of the CHRONIC Care Act

Among other things, the law does the following:

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  • Gives Medicare Advantage plans more flexibility so they can now cover “non-medical” benefits like bathroom grab bars and wheelchair ramps for the chronically ill
  • Makes more telehealth services (providing health care remotely through electronic means) available for Medicare Advantage members
  • Expands telehealth services for people having stroke symptoms, regardless of their geographic area
  • Provides kidney disease patients with more access to home dialysis through telehealth
  • Establishes a new program in which certain Accountable Care Organizations (groups of health care providers or hospitals who provide coordinated care to Medicare patients) can pay patients to come in for primary care appointments, up to $20 per visit
  • Promotes better coordination of services for people in Special Needs Plans (Medicare Advantage plans for people with particular diseases or characteristics) who also receive Medicaid

Enthusiasm for the Changes

Chernof said the law is a welcome change to a medical delivery system “that is sort of purpose-built for 1971,” and has not fundamentally revised its approach to caring for people who have functional limitations or serious chronic illness.

“What this bill really says is, people who have needs need to get them met in a far more organized way than they’re getting them today, because actually it’s not good for their care. It’s not good for them as people and it’s pretty inefficient,” he said.

An example: Medicare has traditionally put up high barriers to services that could be provided over the telephone. But requiring a person with chronic illness to come to a doctor’s office every time he or she needs care or has a question is inefficient and can be risky, Chernof said. That’s especially true in flu season and for people with weak immune systems, such as those on dialysis.

“If the only way to get your question answered is to plop yourself down in the doctor’s office and potentially be exposed to things like flu — it’s not good care,” Chernof said.

That’s where the new telehealth measures in the CHRONIC Care Act can make a difference, he said.

Getting Care at Home

Another group to benefit from the new law: people enrolled in an Independence at Home program, a project of the Affordable Care Act. Such programs, operating at 14 sites around the country, are testing whether having doctors and nurses provide house calls for the chronically ill and disabled might improve care and cut costs.

Under the law, the number of patients in the program will expand from 10,000 to 15,000, and medical practices can participate in the demonstration project for up to seven years, instead of five.

The program “has proven in its early phases to be very successful, not just in its economic performance but really improving the lives of older adults,” Chernof said. It has also helped their circle of caregivers, who bear the burden of caring for their serious needs, he added.

According to the Centers for Medicare and Medicaid Services, Independence at Home saved Medicare a total of $7,821,374, an average of $746 per beneficiary, in its second year. On average, patients had fewer hospital readmissions and used inpatient hospital and emergency room services less for conditions such as diabetes, high blood pressure, asthma, pneumonia and urinary tract infection.

Addressing Frustrations

Lack of coordination between Medicare and Medicaid has caused plenty of aggravation for patients, but the CHRONIC Care Act addresses this.

Before the law, Medicare wouldn’t issue a coverage denial letter for something it didn’t consider a benefit, but without the denial letter, Medicaid also wouldn’t pay, Chernof said. Another hassle: older adults have needed to carry a wallet full of ID cards, one for each program or type of service.

“I see the CHRONIC Care Act as a downpayment on shaping the future — a future that people want. And I actually think that strong bipartisan support is a recognition of that, because ultimately, after our political affiliations, we’re all human,” said Chernof.

See more about the CHRONIC Care Act in this report by The SCAN Foundation.

By Emily Gurnon
Emily Gurnon is Senior Content Editor covering health and caregiving for Next Avenue. She previously spent 20 years as a newspaper reporter in the San Francisco Bay Area and St. Paul. Write to her at [email protected]@EmilyGurnon

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