New CHRONIC Care Act Expands Medicare Benefits
Last month, as a part of the Bipartisan Budget Act of 2018, the CHRONIC Care Act became law. Titled CHRONIC for “Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care,” the act is designed for seniors and Medicare eligibles with high medical needs and is focused on strengthening programs for those who are eligible for both Medicare and Medicaid.
Medicare Advantage & Telehealth
The CHRONIC Care Act expands Medicare Advantage plans by allowing them to cover “nonmedical” benefits. Medicare Advantage plans normally cover “Durable Medical Equipment,” or DME, but that does not include home modifications. Now, with the CHRONIC Care Act, Medicare Advantage plans can cover items like wheelchair ramps, bathroom handlebars, and stair lifts (depending on the patient’s condition and medical need).
Medicare and CMS guidelines are strict about virtual care and helpful services like telephonic enrollments. For the elderly and disabled, visiting providers in person for every little concern is tiresome, expensive, and potentially dangerous. This new Act will expand Medicare Advantage coverage for virtual health services so that the elderly and disabled will no longer be forced to leave their home just to receive an antibiotic or speak to a doctor. It even specifically opens up telehealth services for those with stroke symptoms. A medical professional can help them out BEFORE they attempt to leave their home.
In addition to telehealth services, the CHRONIC Care Act also expands access to home care services. Kidney disease patients may now be able to access in-home dialysis treatments. Those with kidney disease and other chronic medical concerns often have weakened immune systems, and frequent trips to doctor’s offices and hospitals can lead to infections and illnesses that only worsen existing medical concerns.
A part of this includes the expansion of the Independence at Home program. The program originated with the Affordable Care Act in 14 sites around the country to send doctors to patients with chronic illnesses and disabilities. Not only does it prevent patients from having to leave their homes, but it also can also improve care and cut costs. The CHRONIC Care Act increases the number of patients involved from 10,000 to 15,000 and allows the medical practices involved to participate for up to seven years (up from five). According to CMS, the Independence at Home program has saved an average of about $750 per beneficiary.
Under the new act, some Accountable Care Organizations can now actually pay patients to come in for their wellness exams and other items they would normally turn to their primary physician for (up to $20 per visit). This will benefit the ACOs by bringing in new patients, and benefit the patients by creating more of a centralized care environment.
On the same token, the act encourages better coordination for Special Needs Plan services. It encourages Medicare and Medicaid to work more closely together for seniors and Medicare eligibles with special needs.
These updates mean that seniors and Medicare eligibles with chronic conditions and illnesses will have an easier time accessing the care and coverage they need. We can be a part of helping them navigate the process of finding the right Medicare Advantage plan, now that these additional CHRONIC benefits are a possibility.
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